Healthcare Provider Details

I. General information

NPI: 1962051490
Provider Name (Legal Business Name): DIEM VO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2019
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10515 W CENTRAL AVE
WICHITA KS
67212-5103
US

IV. Provider business mailing address

10515 W CENTRAL AVE
WICHITA KS
67212-5103
US

V. Phone/Fax

Practice location:
  • Phone: 316-729-0431
  • Fax:
Mailing address:
  • Phone: 316-729-0431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number1-109198
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: