Provider Demographics
NPI:1750918660
Name:WINTERCORN, LRAE URAINUZ (FNP-BC)
Entity type:Individual
Prefix:
First Name:LRAE
Middle Name:URAINUZ
Last Name:WINTERCORN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S 19TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-1123
Mailing Address - Country:US
Mailing Address - Phone:479-372-3700
Mailing Address - Fax:479-207-9643
Practice Address - Street 1:201 S 19TH ST STE A
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1123
Practice Address - Country:US
Practice Address - Phone:479-372-3700
Practice Address - Fax:479-207-9643
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR124349363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner