Provider Demographics
NPI:1114922895
Name:NGUYEN, MARIA T (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1100 N SAINT FRANCIS ST
Mailing Address - Street 2:STE 130
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-2865
Mailing Address - Country:US
Mailing Address - Phone:316-264-3505
Mailing Address - Fax:316-264-0908
Practice Address - Street 1:1100 N SAINT FRANCIS ST
Practice Address - Street 2:STE 130
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-2865
Practice Address - Country:US
Practice Address - Phone:316-264-3505
Practice Address - Fax:316-264-0908
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2013-08-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS1500636363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100411680BMedicaid
KSP48153Medicare UPIN
KS100411680BMedicaid