NPI 1043773922

Dominique Michele Waterbury

Practitioner Driver Fort Smith, AR

Practice location

Address: 5400 Euper Ln, Fort Smith, AR 72903-3232
Phone: (479) 755-6601
Mailing address: 1900 Stillwater Dr, Jonesboro, AR 72404-9119

Registered specialties

Driver Primary

Other Service Providers Taxonomy 172A00000X Licence 928984961 (AR)

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Registry record

NPI: 1043773922
Entity type: Individual
Sex (as registered): Female
NPI issued: 9 Apr 2019
Record last updated: 9 Apr 2019

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.