Provider Demographics
NPI:1508399502
Name:RUBLEY, ROSANNA NICOLE (APRN)
Entity type:Individual
Prefix:
First Name:ROSANNA
Middle Name:NICOLE
Last Name:RUBLEY
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 SW I ST # 200
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72713-0200
Mailing Address - Country:US
Mailing Address - Phone:479-268-7640
Mailing Address - Fax:479-250-9817
Practice Address - Street 1:4100 SW I ST # 200
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72713-0200
Practice Address - Country:US
Practice Address - Phone:479-268-7640
Practice Address - Fax:479-250-9817
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005115363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily