Provider Demographics
NPI:1558748657
Name:HATFIELD, MARIE LAUREN
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:LAUREN
Last Name:HATFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MARIE
Other - Middle Name:LAUREN
Other - Last Name:CUTRARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4190 RAVENWOOD
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-0575
Mailing Address - Country:US
Mailing Address - Phone:479-263-9376
Mailing Address - Fax:623-666-6644
Practice Address - Street 1:5230 WILLOW CREEK DR STE 201
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-0899
Practice Address - Country:US
Practice Address - Phone:479-927-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-28
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004330282N00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR217800758Medicaid