Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 78296 | KS |
NPI | 1013494467 |
---|---|
Provider Name | Andrea Stafford |
First Address | Wichita, KS 67203-2982 |
Second Address | Wichita, KS 67203-2982 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2018 |
Last Update Date | 27/07/2018 |