Healthcare Provider Details

I. General information

NPI: 1568884161
Provider Name (Legal Business Name): MARIE ESPINOZA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2014
Last Update Date: 01/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E 9TH ST N
WICHITA KS
67214-3115
US

IV. Provider business mailing address

635 N MAIN ST
WICHITA KS
67203-3602
US

V. Phone/Fax

Practice location:
  • Phone: 316-660-7300
  • Fax:
Mailing address:
  • Phone: 316-660-7600
  • Fax: 316-660-7510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number13-113394-081
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: