Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 04-32004 | KS |
NPI | 1104861590 |
---|---|
Provider Name | Dr. Mercedes V Judkins |
First Address | Wichita, KS 67201-1897 |
Second Address | Wichita, KS 67214-3821 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2006 |
Last Update Date | 09/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200405180A | (05) | KS |