Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 53-79184 | KS |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 53-79184-112 | KS |
NPI | 1023658663 |
---|---|
Provider Name | Boniface Ndungu Gitau |
First Address | Wichita, KS 67218-3505 |
Second Address | Wichita, KS 67218-3505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2020 |
Last Update Date | 12/01/2020 |