=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356434351
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | POLLY J RICE-MAHER APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 10/28/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9333 E 21ST ST N
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67206-2927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-634-4700
-----------------------------------------------------
Fax | 316-634-4770
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 467
-----------------------------------------------------
City | NEWTON
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67114-0467
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-284-6400
-----------------------------------------------------
Fax | 316-284-6491
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 364S00000X
-----------------------------------------------------
Taxonomy Name | Clinical Nurse Specialist
-----------------------------------------------------
License Number | 74310
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------