Healthcare Provider Details

I. General information

NPI: 1477716124
Provider Name (Legal Business Name): MARIA ENGELHARDT RN, CCM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 W HARDTNER AVE
WICHITA KS
67212-4634
US

IV. Provider business mailing address

10101 W HARDTNER AVE
WICHITA KS
67212-4634
US

V. Phone/Fax

Practice location:
  • Phone: 316-721-6860
  • Fax: 316-721-1099
Mailing address:
  • Phone: 316-721-6860
  • Fax: 316-721-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number1438716072
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: