Healthcare Provider Details

I. General information

NPI: 1568162576
Provider Name (Legal Business Name): VALENTINE DOOMS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2023
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 E KELLOGG DR
WICHITA KS
67218-1607
US

IV. Provider business mailing address

4810 E 27TH ST N
WICHITA KS
67220-2628
US

V. Phone/Fax

Practice location:
  • Phone: 316-685-2221
  • Fax: 316-239-2749
Mailing address:
  • Phone: 316-573-9779
  • Fax: 316-239-2749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number13-96142
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: