Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 7512 | KS |
NPI | 1003127424 |
---|---|
Provider Name | Jennifer Baas |
First Address | Wichita, KS 67214 |
Second Address | Wichita, KS 67214 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2010 |
Last Update Date | 30/06/2010 |