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MR. NATHAN GERRELL FAWBUSH APRN

Family >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1811401193

Individual Registrant:
MR. NATHAN GERRELL FAWBUSH APRN
Gender: M
Not Sole Proprietor

Location and contact information for practice:
130 JF BLVD  LONOKE, AR 72086 US
Tel: 501-552-7979  Fax: 501-552-7978

Contact information for business:
130 JF BLVD  LONOKE, AR 72086 US
Tel: 501-552-7979  Fax: 501-552-7978

Registration Information:
NPI: 1811401193
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363LF0000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
Family
ARA005332

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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