Provider Demographics
NPI:1942432661
Name:ARBUCKLE, SUJEN (APN)
Entity Type:Individual
Prefix:
First Name:SUJEN
Middle Name:
Last Name:ARBUCKLE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 GREATHOUSE SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-8701
Mailing Address - Country:US
Mailing Address - Phone:479-684-3132
Mailing Address - Fax:479-684-3098
Practice Address - Street 1:4301 GREATHOUSE SPRINGS RD
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-8701
Practice Address - Country:US
Practice Address - Phone:479-684-3132
Practice Address - Fax:479-684-3098
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR72752363LN0000X
ARAO1876363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5V268C072Medicare PIN