Basic Information
| Provider Information | |||||||||
| NPI: | 1437332434 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARY A SHENKER CRNA PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 55990 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722155990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012270700 | ||||||||
| FaxNumber: | 5012270744 | ||||||||
| Practice Location | |||||||||
| Address1: | 2900 MEDICAL CENTER PKWY | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | BENTONVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727123204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012270700 | ||||||||
| FaxNumber: | 5012270744 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2007 | ||||||||
| LastUpdateDate: | 12/12/2007 | ||||||||
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| AuthorizedOfficialLastName: | SHENKER | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5012270700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | C00185 | AR | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.