Healthcare Provider Details

I. General information

NPI: 1669009619
Provider Name (Legal Business Name): DALTON NUSE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CLOUD AVE
ANDOVER KS
67002-8824
US

IV. Provider business mailing address

225 E CLOUD AVE
ANDOVER KS
67002-8824
US

V. Phone/Fax

Practice location:
  • Phone: 316-733-3725
  • Fax:
Mailing address:
  • Phone: 316-733-3725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number1-100014
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: