Individual
LISA DUBOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
350 SALEM RD STE 1, CONWAY, AR 72034-6166
(501) 336-8300
(501) 329-5508
Mailing address
2400 S 48TH ST, SPRINGDALE, AR 72762-6683
(479) 750-2020
(479) 750-4843
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
R032817
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
224468795
—
AR
Enumeration date
05/19/2016
Last updated
04/30/2020
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