Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | 01-03800 | KS |
NPI | 1407912231 |
---|---|
Provider Name | Randy R. Wheeler |
First Address | Wichita, KS 67213-4814 |
Second Address | Kechi, KS 67067 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2006 |
Last Update Date | 08/07/2007 |