Individual
INIS JANE BARDELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1617 N WASHINGTON, MAGNOLIA, AR 71753-2046
(870) 562-2588
Mailing address
4021 W 8TH ST, LITTLE ROCK, AR 72204-2029
(501) 686-5021
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036129581
IL
207Q00000X
Family Medicine Physician
Primary
E-12712
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036129581
ILLINOIS PHYSICIAN LICENSE
IL
05
—
200496730
—
IN
05
—
PENDING
—
CO
Enumeration date
04/21/2006
Last updated
10/27/2023
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