Healthcare Provider Details

I. General information

NPI: 1043616832
Provider Name (Legal Business Name): ELBA ABREU 139362
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2014
Last Update Date: 11/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7931 W. UNIVERSITY
WICHITA KS
67209-2031
US

IV. Provider business mailing address

7931 W. UNIVERSITY
WICHITA KS
67209
US

V. Phone/Fax

Practice location:
  • Phone: 316-305-3412
  • Fax: 316-425-8181
Mailing address:
  • Phone: 316-305-3412
  • Fax: 316-425-8181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberB087207
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: