Provider Demographics
NPI:1083606255
Name:WHITWORTH, VICTORIA L (CRNA)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:L
Last Name:WHITWORTH
Suffix:
Gender:F
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
Mailing Address - Street 2:STE 250
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2361
Mailing Address - Country:US
Mailing Address - Phone:316-686-7327
Mailing Address - Fax:316-686-1557
Practice Address - Street 1:550 N HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4910
Practice Address - Country:US
Practice Address - Phone:316-962-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS54223207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS144898OtherBCBS
KS100247820CMedicaid
KS100247820BMedicaid
KS144898Medicare PIN
KS100247820CMedicaid
R76241Medicare UPIN
KS100247820BMedicaid