Amanda Gail Divine, Nurse
Nurse Practitioner, Pediatrics in Wichita, KS. Individual provider (NPI-1).
NPI number1336591049
StatusActive
Last updated in NPPESMar 11, 2020
Details
- NPI
- 1336591049
- Entity type
- Individual (NPI-1)
- Name
- Amanda Gail Divine
- Credential
- Nurse
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jul 6, 2016
- Certification date
- Mar 11, 2020
- Last updated
- Mar 11, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LP0200X | Nurse Practitioner, Pediatrics | 53-78308-011 | KS | Yes |
| 363LP0200X | Nurse Practitioner, Pediatrics | 2016013652 | MO |
Practice location
8725 E 32nd St NWichita, KS 67226-4008
Phone 316-201-1202 · Fax 316-201-1251
Mailing address
8725 E 32nd St NWichita, KS 67226-4008
Phone 316-201-1202 · Fax 316-201-1251
Other practice locations
7570 W 21st St N Ste 1006b
Wichita, KS 67205-1773
Wichita, KS 67205-1773
Phone 316-201-1202
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