Healthcare Provider Details

I. General information

NPI: 1396262770
Provider Name (Legal Business Name): LAUREN MARIE ZOGLEMAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 07/21/2022
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3121 N WEBB RD STE 101
WICHITA KS
67226-8119
US

IV. Provider business mailing address

3121 N WEBB RD STE 101
WICHITA KS
67226-8119
US

V. Phone/Fax

Practice location:
  • Phone: 316-928-8930
  • Fax:
Mailing address:
  • Phone: 316-928-8930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-02013
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: