Healthcare Provider Details

I. General information

NPI: 1932158730
Provider Name (Legal Business Name): CYNTHIA J JANTZEN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8533 E 32ND ST N
WICHITA KS
67226-2611
US

IV. Provider business mailing address

8533 E 32ND ST N
WICHITA KS
67226-2611
US

V. Phone/Fax

Practice location:
  • Phone: 316-293-3455
  • Fax: 855-517-9494
Mailing address:
  • Phone: 316-293-2633
  • Fax: 855-517-9494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number44915
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number44915
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: