Healthcare Provider Details

I. General information

NPI: 1093420234
Provider Name (Legal Business Name): HEATHER MICHELLE WURDEMAN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 W 4TH ST STE 3204
LAWRENCE KS
66044-1345
US

IV. Provider business mailing address

825 ROMINE RDG
OSAGE CITY KS
66523-9081
US

V. Phone/Fax

Practice location:
  • Phone: 785-505-5815
  • Fax: 785-505-5278
Mailing address:
  • Phone: 785-219-1526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number53-81842-051
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: