Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 53-45854 | KS |
NPI | 1326001926 |
---|---|
Provider Name | Mrs. Nichole A Hanson |
First Address | Wichita, KS 67201-1897 |
Second Address | Wichita, KS 67218-3713 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2006 |
Last Update Date | 29/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200376330A | (05) | KS |