Healthcare Provider Details

I. General information

NPI: 1255051827
Provider Name (Legal Business Name): MARGARET PTACEK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 ELM ST
MINNEAPOLIS KS
67467-1608
US

IV. Provider business mailing address

429 MEADOWLARK DR
MINNEAPOLIS KS
67467-3007
US

V. Phone/Fax

Practice location:
  • Phone: 785-392-2144
  • Fax:
Mailing address:
  • Phone: 785-488-6045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number104400
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: