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General NPI Number Information
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NPI Number | 1710904255
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Entity Type | Individual
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Provider Name | ELAINE M, COULSON PHYSICIAN ASSISTANT
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Gender | Female
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 08/10/2011
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Provider Practice Location Address
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Address Line | 9415 E. HARRY BLDG 800
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City | WICHITA
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State | KS
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Zip | 67207
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Country | US
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Telephone | 316-686-6303
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Fax | 316-686-6764
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Provider Business Mailing Address
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Address Line | 9415 E. HARRY BUILDING 800
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City | WICHITA
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State | KS
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Zip | 67207
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Country | US
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Telephone | 316-686-6303
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Fax | 316-686-6764
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1338469061
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1500532
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License Number State | KS
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