Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 45474 | KS |
NPI | 1023126778 |
---|---|
Provider Name | Lori L Lair |
First Address | Wichita, KS 67201-7530 |
Second Address | Wichita, KS 67214-4910 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
161265 | BCBS OF KANSAS (01) | KS |
464980 | FIRSTGUARD (01) | KS |