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General NPI Number Information
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NPI Number | 1992661821
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Entity Type | Individual
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Provider Name | SHANA K THONGPHALA
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Gender | Female
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Dates
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Enumeration Date | 01/05/2026
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 1151 N ROCK RD
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City | WICHITA
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State | KS
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Zip | 67206-1262
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Country | US
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Telephone | 316-777-7077
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Fax |
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Provider Business Mailing Address
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Address Line | 1908 S STEPHANIE ST
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City | WICHITA
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State | KS
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Zip | 67207-1108
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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 | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number | 13-126239
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License Number State | KS
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