Healthcare Provider Details

I. General information

NPI: 1972916773
Provider Name (Legal Business Name): SARAH M JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH M ZIELKE RN

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 05/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 N WEBB RD
WICHITA KS
67206
US

IV. Provider business mailing address

1911 N WEBB RD
WICHITA KS
67206-3405
US

V. Phone/Fax

Practice location:
  • Phone: 316-682-7546
  • Fax: 316-682-7554
Mailing address:
  • Phone: 316-682-7546
  • Fax: 316-682-7554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number53-76337-081
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60316269
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201250188NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: