Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 2011010846 | MO |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 75268 | KS |
NPI | 1003107830 |
---|---|
Provider Name | Natalie Christine Lickteig |
First Address | Rantoul, KS 66079-9145 |
Second Address | Kansas City, MO 64145-1650 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2011 |
Last Update Date | 12/08/2013 |