Basic Information
| Provider Information | |||||||||
| NPI: | 1306830575 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAZANDER | ||||||||
| FirstName: | JOANNE | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | ANP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9500 KANIS RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722056324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012021902 | ||||||||
| FaxNumber: | 5012021512 | ||||||||
| Practice Location | |||||||||
| Address1: | 9500 KANIS RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722056324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012021902 | ||||||||
| FaxNumber: | 5012021512 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2005 | ||||||||
| LastUpdateDate: | 01/16/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | A01342 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.