Provider Demographics
NPI:1659414498
Name:WRINKLE, MARIA L
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:L
Last Name:WRINKLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 N PEABODY STREET
Mailing Address - Street 2:PO BOX 1660
Mailing Address - City:MTN VIEW
Mailing Address - State:AR
Mailing Address - Zip Code:72560
Mailing Address - Country:US
Mailing Address - Phone:870-269-7577
Mailing Address - Fax:501-303-3188
Practice Address - Street 1:218 DOGWOOD HOLLOW RD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:AR
Practice Address - Zip Code:72560-7942
Practice Address - Country:US
Practice Address - Phone:870-269-7577
Practice Address - Fax:501-303-3188
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator