Healthcare Provider Details

I. General information

NPI: 1720831704
Provider Name (Legal Business Name): TAMELA UNRUH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2024
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 E KELLOGG DR
WICHITA KS
67218-1607
US

IV. Provider business mailing address

5500 E KELLOGG DR
WICHITA KS
67218-1607
US

V. Phone/Fax

Practice location:
  • Phone: 316-258-8982
  • Fax: 316-681-5599
Mailing address:
  • Phone: 316-258-8982
  • Fax: 316-681-5599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number13-81379
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number13-81379
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: