Healthcare Provider Details

I. General information

NPI: 1942860820
Provider Name (Legal Business Name): SARAH ANNE LIST GAUL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S ANDOVER RD STE A
ANDOVER KS
67002-7924
US

IV. Provider business mailing address

1548 N WOODROW CT
WICHITA KS
67203-2952
US

V. Phone/Fax

Practice location:
  • Phone: 316-833-8926
  • Fax:
Mailing address:
  • Phone: 316-833-8926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: