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>> Dermatology >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1659368967

Individual Registrant:
Gender: F
Not Sole Proprietor

Location and contact information for practice:
15101 GLENWOOD AVE  STANLEY, KS 66223-3154 US
Tel: 913-681-8866  Fax: 913-338-1311

Contact information for business:
PO BOX 741331  ATLANTA, GA 30374-1331 US
Tel: 913-469-0503  Fax: 913-469-5267

Registration Information:
NPI: 1659368967
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207N00000XAllopathic & Osteopathic Physicians

Legacy codes, insurance codes and state license numbers:



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