Healthcare Provider Details

I. General information

NPI: 1124248224
Provider Name (Legal Business Name): NANCY LUCILLE SMITH CST CFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 NO ST FRACIS
WICHITA KS
67214
US

IV. Provider business mailing address

4009 HAVEN DR
DERBY KS
67037
US

V. Phone/Fax

Practice location:
  • Phone: 316-806-8017
  • Fax:
Mailing address:
  • Phone: 316-806-8017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: