Basic Information
| Provider Information | |||||||||
| NPI: | 1821042300 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURCHFIELD | ||||||||
| FirstName: | DANA | ||||||||
| MiddleName: | LYNNE | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12 E APPLEBY RD | ||||||||
| Address2: | CLINIC ADMINISTRATION | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727033901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794631704 | ||||||||
| FaxNumber: | 4794637864 | ||||||||
| Practice Location | |||||||||
| Address1: | 3000 NW A ST | ||||||||
| Address2: | WASHINGTON REGIONAL DIAGNOSTIC CLINIC | ||||||||
| City: | BENTONVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727123985 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4792683050 | ||||||||
| FaxNumber: | 4792730050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 09/13/2010 | ||||||||
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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 | 364SG0600X | R32353 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Gerontology |
ID Information
| ID | Type | State | Issuer | Description | 158940758 | 05 | AR | MEDICAID |