Provider Demographics
NPI:1750316634
Name:EREMIEVA, ANNA (MD)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:
Last Name:EREMIEVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 SE 13TH CT
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7857
Mailing Address - Country:US
Mailing Address - Phone:479-273-9056
Mailing Address - Fax:479-273-6937
Practice Address - Street 1:1000 SE 13TH CT
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-7857
Practice Address - Country:US
Practice Address - Phone:479-273-9056
Practice Address - Fax:479-273-6937
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4592207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR162178001Medicaid
I60848Medicare UPIN
AR5N672Medicare PIN