MEDICARE: PAULA S POND 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
1	363L00000X	Nurse Practitioner	44635	KS
2	207RN0300X	Nephrology Physician	44635	KS

General Provider Information

NPI Number	:	1548235575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA S POND APRN

Provider Business Mailing Address
First Line	:	1035 NORTH EMPORIA, SUITE 105
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67214-2998
Country	:	US
Telephone Number	:	316-263-7285
Fax Number	:	316-263-2666

Provider Business Practice Location Address
First Line	:	1035 NORTH EMPORIA, SUITE 105
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67214-2998
Country	:	US
Telephone Number	:	316-263-7285
Fax Number	:	316-263-2666

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	07/09/2014

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