Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 5345917061 | KS |
NPI | 1013463355 |
---|---|
Provider Name | Mary Suzanne Meeker |
First Address | Wichita, KS 67206-3413 |
Second Address | Wichita, KS 67206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2016 |
Last Update Date | 28/08/2016 |