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NPI Code Detail

MEDICARE: MRS. AMANDA BETH ABASOLO APRN

MEDICARE: MRS. AMANDA BETH ABASOLO APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner5376110091KS

General Provider Information

NPI Number : 1073946455
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AMANDA BETH ABASOLO APRN
Provider Business Mailing Address
First Line : 426 E QUAIL RIDGE CT
Second Line :
City : MULVANE
State : KS
Zip : 67110-1136
Country : US
Telephone Number : 316-613-1057
Fax Number :
Provider Business Practice Location Address
First Line : 755 W LINCOLN ST
Second Line :
City : WICHITA
State : KS
Zip : 67213-4527
Country : US
Telephone Number : 316-866-2000
Fax Number : 316-866-2084
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2013
Last Update Date : 11/27/2019

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