Provider Demographics
NPI:1366637498
Name:WESLEY, LAJARLYN ROSE (RN)
Entity Type:Individual
Prefix:
First Name:LAJARLYN
Middle Name:ROSE
Last Name:WESLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 BLUE MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-6399
Mailing Address - Country:US
Mailing Address - Phone:501-269-5813
Mailing Address - Fax:
Practice Address - Street 1:501 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GURDON
Practice Address - State:AR
Practice Address - Zip Code:71743-1243
Practice Address - Country:US
Practice Address - Phone:870-353-4329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR78563163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator