Provider Demographics
NPI:1366258774
Name:LUEDDERS-EAST, MISHANN (APRN-CNP)
Entity type:Individual
Prefix:
First Name:MISHANN
Middle Name:
Last Name:LUEDDERS-EAST
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4196 HIGHWAY 62 412 STE A
Mailing Address - Street 2:
Mailing Address - City:HARDY
Mailing Address - State:AR
Mailing Address - Zip Code:72542-8002
Mailing Address - Country:US
Mailing Address - Phone:870-895-2015
Mailing Address - Fax:
Practice Address - Street 1:4196 HIGHWAY 62 412 STE A
Practice Address - Street 2:
Practice Address - City:HARDY
Practice Address - State:AR
Practice Address - Zip Code:72542-8002
Practice Address - Country:US
Practice Address - Phone:870-895-2015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR120637363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology