Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 74823 | KS |
NPI | 1669685160 |
---|---|
Provider Name | Rhonda Smith |
First Address | Wichita, KS 67205-2525 |
Second Address | Wichita, KS 67203-4904 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 08/07/2007 |