Basic Information
Provider Information
NPI: 1639419427
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MANSFIELD
FirstName: JENNIFER
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 2578
Address2:  
City: BATESVILLE
State: AR
PostalCode: 725032578
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 25 GAP RD
Address2:  
City: BATESVILLE
State: AR
PostalCode: 725018679
CountryCode: US
TelephoneNumber: 8707938900
FaxNumber: 8707938959
Other Information
ProviderEnumerationDate: 02/15/2013
LastUpdateDate: 02/28/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000XR092894ARY Nursing Service ProvidersRegistered Nurse 

No ID Information.


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