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General NPI Number Information
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NPI Number | 1609336783
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Entity Type | Individual
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Provider Name | ANDA MARIE ENTZ APRN
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Gender | Female
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Dates
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Enumeration Date | 03/23/2019
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Last Update Date | 07/06/2023
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Provider Practice Location Address
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Address Line | 1776 CENTENNIAL DR
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City | MCPHERSON
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State | KS
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Zip | 67460-9301
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Country | US
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Telephone | 620-718-8118
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Fax | 620-241-1351
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Provider Business Mailing Address
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Address Line | 971 90TH
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City | PEABODY
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State | KS
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Zip | 66866-9459
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Country | US
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Telephone | 167-723-3306
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 53-78537
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License Number State | KS
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