Healthcare Provider Details

I. General information

NPI: 1609843515
Provider Name (Legal Business Name): SUSAN K PFANNENSTIEL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3211 S SENECA ST
WICHITA KS
67217-3348
US

IV. Provider business mailing address

PO BOX 932958
CLEVELAND OH
44193-0028
US

V. Phone/Fax

Practice location:
  • Phone: 316-670-1582
  • Fax:
Mailing address:
  • Phone: 316-670-1582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number45207
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: