Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1101X | Ophthalmic Assistant | 15000 | KS |
NPI | 1407848161 |
---|---|
Provider Name | Geraldine Mcfadden |
First Address | Wichita, KS 67213-4819 |
Second Address | Wichita, KS 67213-4819 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2005 |
Last Update Date | 08/07/2007 |