Provider Demographics
NPI:1891130555
Name:WLEKLINSKI, DONALD E (APRN)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:E
Last Name:WLEKLINSKI
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 S CARL ST BLDG 2
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-4108
Mailing Address - Country:US
Mailing Address - Phone:479-238-2552
Mailing Address - Fax:479-373-6737
Practice Address - Street 1:920 S CARL ST BLDG 2
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-4108
Practice Address - Country:US
Practice Address - Phone:479-238-2552
Practice Address - Fax:479-373-6737
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003818363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR199300758Medicaid