Organization
APN RAINBOW PEDIATRIC SERVICES, PLLC
Active
Other names
Rainbow Pediatric Services, PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
MARILOU SHREVE-DOFFIN APN (OWNER)
(479) 464-8231
Entity
Organization
Contact information
Practice address
5507 WALSH LANE, STE 101, ROGERS, AR 72758-8941
(479) 464-8231
(479) 464-8230
Mailing address
5507 WALSH LANE, STE 101, ROGERS, AR 72758-8941
(479) 464-8231
(479) 464-8230
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
AR
363L00000X
Nurse Practitioner
Primary
A01589
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
155833762
—
AR
01
—
5F294
AR BCBS
AR
Enumeration date
05/31/2007
Last updated
09/30/2008
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