Provider Demographics
NPI:1134966542
Name:NEMALIDINNE, KRISHNA VANI
Entity type:Individual
Prefix:
First Name:KRISHNA VANI
Middle Name:
Last Name:NEMALIDINNE
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 1:3400 S BOWMAN RD APT 1207
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4666
Mailing Address - Country:US
Mailing Address - Phone:469-823-7814
Mailing Address - Fax:
Practice Address - Street 1:4301 W MARKHAM ST # 501
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-686-5377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program