Provider Demographics
NPI:1083224786
Name:ENRIQUEZ, ANTHONY M (CRNA)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:M
Last Name:ENRIQUEZ
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8080 E CENTRAL AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2367
Mailing Address - Country:US
Mailing Address - Phone:316-686-7327
Mailing Address - Fax:316-686-1557
Practice Address - Street 1:8080 E CENTRAL AVE STE 250
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2367
Practice Address - Country:US
Practice Address - Phone:316-686-7327
Practice Address - Fax:316-686-1557
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS130404367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered