Provider Demographics
NPI:1205030145
Name:WONDRA, WILLIAM PAUL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:PAUL
Last Name:WONDRA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:216 W WATERFORD CT
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-8813
Mailing Address - Country:US
Mailing Address - Phone:316-733-8445
Mailing Address - Fax:316-733-8445
Practice Address - Street 1:141 W ELM ST
Practice Address - Street 2:SEDGWICK COUNTY DETENTION FACILITY
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-3848
Practice Address - Country:US
Practice Address - Phone:316-383-7685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1500756363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1500756OtherSTATE LICENSE