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General NPI Number Information
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NPI Number | 1437130192
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Entity Type | Individual
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Provider Name | MARTHA SEPULVADO
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Gender | Female
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Dates
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Enumeration Date | 11/09/2005
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Last Update Date | 07/13/2026
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Provider Practice Location Address
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Address Line | 550 POPE AVE
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City | FORT LEAVENWORTH
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State | KS
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Zip | 66027-2332
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Country | US
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Telephone | 913-684-6348
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Fax |
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Provider Business Mailing Address
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Address Line | 4512 PARK 10 CT
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City | LEAVENWORTH
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State | KS
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Zip | 66048-5554
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number | 1377240011
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License Number State | KS
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