Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224P00000X | Prosthetist |
NPI | 1033725122 |
---|---|
Provider Name | Tanisha Lee Alexander |
First Address | Wichita, KS 67203-1240 |
Second Address | Wichita, KS 67203-1240 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2020 |
Last Update Date | 23/09/2020 |