Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 76331 | KS |
NPI | 1003224932 |
---|---|
Provider Name | Marco Katada |
First Address | Garden City, KS 67846-0531 |
Second Address | Garden City, KS 67846-5958 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2014 |
Last Update Date | 23/07/2014 |