Provider Demographics
NPI:1376561761
Name:HAMELINK, MARK C (CRNA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:C
Last Name:HAMELINK
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 HWY 375 E
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953
Mailing Address - Country:US
Mailing Address - Phone:479-216-3309
Mailing Address - Fax:
Practice Address - Street 1:311 MORROW ST N
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-2516
Practice Address - Country:US
Practice Address - Phone:479-243-0971
Practice Address - Fax:843-664-3723
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPRN1492367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN1061Medicaid
SCQ333027234Medicare ID - Type Unspecified
SCAN1061Medicaid