Healthcare Provider Details

I. General information

NPI: 1609631225
Provider Name (Legal Business Name): GIDEON ORANG'I APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3343 W CENTRAL AVE
WICHITA KS
67203-4917
US

IV. Provider business mailing address

1007 N EMPORIA AVE
WICHITA KS
67214-2908
US

V. Phone/Fax

Practice location:
  • Phone: 316-260-4110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number53-82973-061
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number53-82973-061
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: