Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 45912 | KS |
NPI | 1023119765 |
---|---|
Provider Name | Mrs. Debra L Rezac |
First Address | Onaga, KS 66521-9547 |
Second Address | Onaga, KS 66521-9547 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 29/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200404000A | (05) | KS |