Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 94-08572 | KS |
N | 111NI0900X | Internist | 94-08572 | KS |
N | 207RR0500X | Rheumatology | 04-43181 | KS |
Y | 207RR0500X | Rheumatology | TRN27052 | FL |
NPI | 1104206077 |
---|---|
Provider Name | Rawaa Ebrahem |
First Address | Wichita, KS 67206-3405 |
Second Address | Wichita, KS 67206-3405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2015 |
Last Update Date | 07/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201294670A | (05) | KS |