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General NPI Number Information
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NPI Number | 1336427582
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Entity Type | Organization
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Legal Business Name | WICHITA STATE UNIVERSITY
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Dates
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Enumeration Date | 07/21/2011
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Last Update Date | 07/21/2011
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Provider Practice Location Address
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Address Line | 2838 N. OLIVER
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City | WICHITA
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State | KS
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Zip | 67220-0157
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Country | US
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Telephone | 316-978-5662
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Fax | 316-978-3025
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Provider Business Mailing Address
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Address Line | 1845 FAIRMOUNT ST BOX 157
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City | WICHITA
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State | KS
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Zip | 67260-0043
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Country | US
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Telephone | 316-978-5662
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Fax | 316-978-3025
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MRS. JO DENISE CLEPPER
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Credential | RN
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Telephone | 316-978-5662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State | KS
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