Healthcare Provider Details

I. General information

NPI: 1518359439
Provider Name (Legal Business Name): TAI SCHMOTZER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2015
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2318 E CENTRAL AVE
WICHITA KS
67214-4436
US

IV. Provider business mailing address

2318 E CENTRAL AVE
WICHITA KS
67214-4436
US

V. Phone/Fax

Practice location:
  • Phone: 316-262-2415
  • Fax: 316-262-0138
Mailing address:
  • Phone: 316-262-2415
  • Fax: 316-262-0138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number53-76704-081
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: