Provider Demographics
NPI:1659851400
Name:PADILLA, LORENA AIMEE (CNP)
Entity Type:Individual
Prefix:
First Name:LORENA
Middle Name:AIMEE
Last Name:PADILLA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 NAPA LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-7818
Mailing Address - Country:US
Mailing Address - Phone:479-445-3824
Mailing Address - Fax:
Practice Address - Street 1:3003 NAPA LN
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-7818
Practice Address - Country:US
Practice Address - Phone:479-445-3824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005606363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology