Facts
- Status
- A
- Credential
- OTR
- Type
- Individual
- Enumeration date
- 2007-05-21
- Last updated
- 2007-07-08
Specialties
Licenses
- License KS
- 001000
Location
- Practice location
- 7668 COUNTY ROAD BB
- City
- QUINTER KS
- Postal code
- 677526129
- Phone
- 785-754-3377
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.