Provider Demographics
NPI:1952757254
Name:WEMMERUS, EDWARD C (ARNP, CN-P)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:C
Last Name:WEMMERUS
Suffix:
Gender:M
Credentials:ARNP, CN-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4620 ROGERS AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-3121
Mailing Address - Country:US
Mailing Address - Phone:479-384-5380
Mailing Address - Fax:479-384-5382
Practice Address - Street 1:4620 ROGERS AVE STE 101
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3121
Practice Address - Country:US
Practice Address - Phone:479-384-5380
Practice Address - Fax:479-384-5382
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2023-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK92961364SF0001X
AR218161364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health