MEDICARE: KRISTI D UNRUH APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	53-78684-101	KS

General Provider Information

NPI Number	:	1003476904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTI D UNRUH APRN

Provider Business Mailing Address
First Line	:	372 70TH
Second Line	:
City	:	NEWTON
State	:	KS
Zip	:	67114-8100
Country	:	US
Telephone Number	:	620-345-6867
Fax Number	:

Provider Business Practice Location Address
First Line	:	1755 E 61ST ST N
Second Line	:
City	:	PARK CITY
State	:	KS
Zip	:	67219-1917
Country	:	US
Telephone Number	:	316-440-4466
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2019
Last Update Date	:	06/13/2019

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Directions to “ KRISTI D UNRUH APRN” Practice Location

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