Provider Demographics
NPI:1295192847
Name:SUDBRINK, JANICE (APRN)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:SUDBRINK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 DALLAS ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-4278
Mailing Address - Country:US
Mailing Address - Phone:479-259-9286
Mailing Address - Fax:479-259-9362
Practice Address - Street 1:7800 DALLAS ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4278
Practice Address - Country:US
Practice Address - Phone:479-259-9286
Practice Address - Fax:479-259-9362
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004619363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARA004619OtherSTATE LICENSE
ARPENDINGMedicaid
ARPENDINGMedicare PIN