Organization · NPI-2

A-1 IV Rehydration Clinic And Lounge

Nurse Practitioner, Family · Wichita, KS

NPI number1932806783
StatusActive
Last updated in NPPESApr 27, 2023

Details

NPI
1932806783
Entity type
Organization (NPI-2)
Legal business name
A-1 IV Rehydration Clinic And Lounge
Organization subpart
No
Enumeration date
Feb 13, 2023
Certification date
Apr 27, 2023
Last updated
Apr 27, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363LF0000X Nurse Practitioner, Family––Yes

Practice location

450 N 159th St E
Wichita, KS 67230-7704

Phone 316-377-0462

Mailing address

450 N 159th St E
Wichita, KS 67230-7704

Phone 316-377-0462

Authorized official

Teresa Jackson
Owner
3163770462

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