Provider Demographics
NPI:1164474912
Name:GUMPENBERGER, MYRNA LOUISE (ARNP)
Entity Type:Individual
Prefix:
First Name:MYRNA
Middle Name:LOUISE
Last Name:GUMPENBERGER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:SATANTA
Mailing Address - State:KS
Mailing Address - Zip Code:67870-0009
Mailing Address - Country:US
Mailing Address - Phone:620-649-2771
Mailing Address - Fax:620-649-2538
Practice Address - Street 1:401 CHEYENNE STREET
Practice Address - Street 2:
Practice Address - City:SATANTA
Practice Address - State:KS
Practice Address - Zip Code:67870-0009
Practice Address - Country:US
Practice Address - Phone:620-649-2771
Practice Address - Fax:620-649-2538
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45231363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100410650CMedicaid
KS13-53645-081OtherREGISTERED NURSE
KS45231OtherARNP #
KS101417OtherBLUE CROSS NUMBER
KS100410650CMedicaid