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INIS JANE BARDELLA M.D.
>> Family Medicine >> Allopathic & Osteopathic PhysiciansRegistrant NPI Number: 1124084926
Individual Registrant: INIS JANE BARDELLA M.D.
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
1617 N WASHINGTON MAGNOLIA, AR 71753-2046 US
Tel: 870-562-2588 Fax: --
Tel: 870-562-2588 Fax: --
Contact information for business:
4021 W 8TH ST LITTLE ROCK, AR 72204-2029 US
Tel: 501-686-5021 Fax: --
Tel: 501-686-5021 Fax: --
Registration Information:
NPI: 1124084926
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 207Q00000X | Allopathic & Osteopathic Physicians Family Medicine | IL | 036129581 |
| Y | 207Q00000X | Allopathic & Osteopathic Physicians Family Medicine | AR | E-12712 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 200496730 | IN | 05 | |
| ILLINOIS PHYSICIAN LICENSE | 036129581 | IL | 01 |
| PENDING | CO | 05 |
