Healthcare Provider Details

I. General information

NPI: 1972145803
Provider Name (Legal Business Name): AMY M RADATZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2019
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 E CRAWFORD ST
SALINA KS
67401-5103
US

IV. Provider business mailing address

737 E CRAWFORD ST
SALINA KS
67401-5103
US

V. Phone/Fax

Practice location:
  • Phone: 785-827-7261
  • Fax:
Mailing address:
  • Phone: 785-827-7261
  • Fax: 785-833-5702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number53-78996-111
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: