Healthcare Provider Details

I. General information

NPI: 1356434351
Provider Name (Legal Business Name): POLLY J RICE-MAHER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 E 21ST ST N
WICHITA KS
67206-2927
US

IV. Provider business mailing address

PO BOX 467
NEWTON KS
67114-0467
US

V. Phone/Fax

Practice location:
  • Phone: 316-634-4700
  • Fax: 316-634-4770
Mailing address:
  • Phone: 316-284-6400
  • Fax: 316-284-6491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number74310
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: