Provider Demographics
NPI:1376717579
Name:OSWALT, LORIE (RN APN MNSC)
Entity Type:Individual
Prefix:MRS
First Name:LORIE
Middle Name:
Last Name:OSWALT
Suffix:
Gender:F
Credentials:RN APN MNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 SE 28TH ST
Mailing Address - Street 2:STE 2
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3881
Mailing Address - Country:US
Mailing Address - Phone:479-271-0005
Mailing Address - Fax:479-271-0005
Practice Address - Street 1:1200 SE 28TH ST
Practice Address - Street 2:STE 2
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3881
Practice Address - Country:US
Practice Address - Phone:479-271-0005
Practice Address - Fax:479-271-0005
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03018ANP363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR191390758Medicaid