Healthcare Provider Details

I. General information

NPI: 1073941316
Provider Name (Legal Business Name): STUART NELSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2013
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S TOPEKA ST
WICHITA KS
67211-4132
US

IV. Provider business mailing address

1600 S TOPEKA ST
WICHITA KS
67211-4132
US

V. Phone/Fax

Practice location:
  • Phone: 316-242-6770
  • Fax: 316-264-1980
Mailing address:
  • Phone: 316-242-6770
  • Fax: 316-264-1980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number3534
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: