Healthcare Provider Details

I. General information

NPI: 1841425352
Provider Name (Legal Business Name): NICHOLAS JAMES WAKEFIELD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22557 S WAVERLY RD
SPRING HILL KS
66083-4534
US

IV. Provider business mailing address

22557 S WAVERLY RD
SPRING HILL KS
66083-4534
US

V. Phone/Fax

Practice location:
  • Phone: 913-238-3313
  • Fax:
Mailing address:
  • Phone: 913-238-3313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: