Healthcare Provider Details

I. General information

NPI: 1285683599
Provider Name (Legal Business Name): JACQUE ELAINE EDIGER ARNP,BC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 E KELLOGG DR BLDG 5- ROBERT J DOLE VA MEDICAL CENTER
WICHITA KS
67218-1607
US

IV. Provider business mailing address

404 S OSAGE ST
CALDWELL KS
67022-1651
US

V. Phone/Fax

Practice location:
  • Phone: 316-634-3058
  • Fax: 316-634-3091
Mailing address:
  • Phone: 620-845-6852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number74824
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: