Healthcare Provider Details

I. General information

NPI: 1386846475
Provider Name (Legal Business Name): ANNETTE DIANE VANANNE ARNP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 N STATE ST
IOLA KS
66749-1677
US

IV. Provider business mailing address

PO BOX 1832
PITTSBURG KS
66762-1832
US

V. Phone/Fax

Practice location:
  • Phone: 620-380-6600
  • Fax: 620-380-6215
Mailing address:
  • Phone: 888-777-9170
  • Fax: 620-232-5819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number220441
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number45194
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: