Provider Demographics
NPI:1407801731
Name:BEBENSEE, LONETTE A (DO)
Entity Type:Individual
Prefix:
First Name:LONETTE
Middle Name:A
Last Name:BEBENSEE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 CHESTNUT ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-5321
Mailing Address - Country:US
Mailing Address - Phone:479-471-4445
Mailing Address - Fax:479-474-2026
Practice Address - Street 1:2020 CHESTNUT ST
Practice Address - Street 2:SUITE 108
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-5321
Practice Address - Country:US
Practice Address - Phone:479-471-4445
Practice Address - Fax:479-474-2026
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4053208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G30035Medicare UPIN
AR5M905Medicare ID - Type UnspecifiedARKANSAS MEDICARE