Healthcare Provider Details

I. General information

NPI: 1184927352
Provider Name (Legal Business Name): WENDY LEWIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2010
Last Update Date: 12/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 N PERSHING ST
WICHITA KS
67208-2826
US

IV. Provider business mailing address

1016 N PERSHING ST
WICHITA KS
67208-2826
US

V. Phone/Fax

Practice location:
  • Phone: 316-239-1966
  • Fax:
Mailing address:
  • Phone: 316-239-1966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number13-107261-102
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: