Individual
TANEIKA BRANCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SPECIALIST
Contact information
Practice address
315 E UNION AVE, OSCEOLA, AR 72370-3235
(870) 563-1331
(870) 563-1334
Mailing address
315 E UNION AVE, OSCEOLA, AR 72370-3235
(870) 563-1331
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
233760795
—
AR
Enumeration date
06/25/2019
Last updated
06/25/2019
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