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General NPI Number Information
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NPI Number | 1578939286
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Entity Type | Individual
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Provider Name | MARY MAHURIN RN
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Gender | Female
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Dates
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Enumeration Date | 08/17/2015
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Last Update Date | 08/17/2015
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Provider Practice Location Address
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Address Line | 1929 W 21ST ST N
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City | WICHITA
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State | KS
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Zip | 67203-2106
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Country | US
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Telephone | 316-660-7750
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Fax | 316-660-7851
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Provider Business Mailing Address
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Address Line | 934 N WATER ST
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City | WICHITA
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State | KS
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Zip | 67203-3838
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Country | US
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Telephone | 316-660-7600
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Fax | 316-941-5075
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 128120
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License Number State | KS
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