Organization
GRAY-MILLENBAUGH PRACTITIONER HEALTHCARE, LLC
Active
Organization
GRAY-MILLENBAUGH PRACTITIONER HEALTHCARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANA GRAY MILLENBAUGH MSN, APRN, BC (OWNER)
(870) 329-4202
Entity
Organization
Contact information
Practice address
3801 CAMDEN RD, CHAPEL VILLAGE 1 SUITE 12, PINE BLUFF, AR 71603-4612
(870) 534-4847
(870) 534-4884
Mailing address
3801 CAMDEN RD, CHAPEL VILLAGE 1 SUITE 12, PINE BLUFF, AR 71603-4612
(870) 534-4847
(870) 534-4884
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
A002944
AR
261QE0002X
Emergency Care Clinic/Center
A002944
AR
261QH0100X
Health Service Clinic/Center
A002944
AR
261QP2300X
Primary Care Clinic/Center
A002944
AR
Other
Enumeration date
06/09/2015
Last updated
06/09/2015
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