Provider Demographics
NPI:1497878904
Name:DEPARTMENT OF HEALTH AND HUMAN SERVICES DIVISION OF HEALTH
Entity Type:Organization
Organization Name:DEPARTMENT OF HEALTH AND HUMAN SERVICES DIVISION OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RNP II
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:RNP
Authorized Official - Phone:501-772-7875
Mailing Address - Street 1:3108 TANNER TRL
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-1539
Mailing Address - Country:US
Mailing Address - Phone:501-772-7875
Mailing Address - Fax:
Practice Address - Street 1:5800 W 10TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-1752
Practice Address - Country:US
Practice Address - Phone:501-280-4940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP00723251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare