Basic Information
| Provider Information | |||||||||
| NPI: | 1386089712 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUNTORIUS | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CPNP-PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 CHILDRENS WAY # 844 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722023500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013642090 | ||||||||
| FaxNumber: | 5013643929 | ||||||||
| Practice Location | |||||||||
| Address1: | 2601 GENE GEORGE BLVD | ||||||||
| Address2: | |||||||||
| City: | SPRINGDALE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727620845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797256977 | ||||||||
| FaxNumber: | 4797256577 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2013 | ||||||||
| LastUpdateDate: | 03/27/2018 | ||||||||
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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 | 363LP0200X | 2013006662 | MO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | 363LP0200X | A004356 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 213189758 | 05 | AR | MEDICAID |