Provider Demographics
NPI:1326008921
Name:KREBSBACH, ARLENE FRANCES (PA)
Entity Type:Individual
Prefix:MRS
First Name:ARLENE
Middle Name:FRANCES
Last Name:KREBSBACH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ARLENE
Other - Middle Name:FRANCES
Other - Last Name:ARVESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:909 E REPUBLIC RD
Mailing Address - Street 2:SUITE E-104
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-6004
Mailing Address - Country:US
Mailing Address - Phone:417-889-6102
Mailing Address - Fax:417-889-6289
Practice Address - Street 1:3801 S NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5210
Practice Address - Country:US
Practice Address - Phone:417-269-4056
Practice Address - Fax:417-269-5556
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPA112799363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S72453Medicare UPIN