MEDICARE: CHRISTINA WANKUM

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	106H00000X	Marriage & Family Therapist	03625-T	KS

General Provider Information

NPI Number	:	1093548570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA WANKUM

Provider Business Mailing Address
First Line	:	3033 N TEE TIME
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67205-1911
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8080 E CENTRAL AVE STE 190
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67206-2389
Country	:	US
Telephone Number	:	316-260-3777
Fax Number	:

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

Provider Enumeration Date	:	08/21/2024
Last Update Date	:	08/21/2024

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Directions to “ CHRISTINA WANKUM ” Practice Location

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