Healthcare Provider Details

I. General information

NPI: 1528426129
Provider Name (Legal Business Name): LINDA ZOLLARS APRN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2016
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 FAIRMOUNT 209 AHLBERG HL
WICHITA KS
67260-0001
US

IV. Provider business mailing address

1845 FAIRMOUNT 209 AHLBERG HL
WICHITA KS
67260-0001
US

V. Phone/Fax

Practice location:
  • Phone: 316-978-3620
  • Fax: 316-978-3517
Mailing address:
  • Phone: 316-978-3620
  • Fax: 316-978-3517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-44541-052
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: