Organization
BOHANNAN ANESTHESIA PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. HOLLY RAE BOHANNAN CRNA, MSNA (OWNER)
(479) 530-6649
Entity
Organization
Contact information
Practice address
3737 W WALNUT ST, ROGERS, AR 72756-1839
(479) 246-1751
Mailing address
12688 MILLER CHURCH RD, BENTONVILLE, AR 72712-9041
(479) 530-6649
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
261QS0132X
Ophthalmologic Surgery Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
163654001
—
AR
05
—
200330120
—
OK
01
—
771165401
AR BREAST CARE
AR
05
—
914302906
—
MO
Enumeration date
11/13/2018
Last updated
11/13/2018
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