Provider Demographics
NPI:1053047969
Name:ENGELBERGER, CYRECE DAWN (APRN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:CYRECE
Middle Name:DAWN
Last Name:ENGELBERGER
Suffix:
Gender:F
Credentials:APRN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CARR ST
Mailing Address - Street 2:
Mailing Address - City:PEA RIDGE
Mailing Address - State:AR
Mailing Address - Zip Code:72751-2782
Mailing Address - Country:US
Mailing Address - Phone:479-488-6415
Mailing Address - Fax:
Practice Address - Street 1:200 CARR ST
Practice Address - Street 2:
Practice Address - City:PEA RIDGE
Practice Address - State:AR
Practice Address - Zip Code:72751-2782
Practice Address - Country:US
Practice Address - Phone:479-488-6415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR222011363L00000X
ARR076767163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse