Healthcare Provider Details

I. General information

NPI: 1215797618
Provider Name (Legal Business Name): LISA ANN MOLT BSN, RN, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA ANN WHITE BSN, RN

II. Dates (important events)

Enumeration Date: 03/21/2024
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

834 N SOCORA ST STE 4
WICHITA KS
67212-3729
US

IV. Provider business mailing address

834 N SOCORA ST STE 4
WICHITA KS
67212-3729
US

V. Phone/Fax

Practice location:
  • Phone: 316-440-2802
  • Fax: 316-440-2809
Mailing address:
  • Phone: 316-440-2802
  • Fax: 316-440-2809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number110430
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: