Provider Demographics
NPI:1255679809
Name:BROST, MARY (APRN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BROST
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1131 S CLIFTON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-2955
Mailing Address - Country:US
Mailing Address - Phone:316-462-1040
Mailing Address - Fax:316-462-1042
Practice Address - Street 1:1131 S CLIFTON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-2955
Practice Address - Country:US
Practice Address - Phone:316-462-1040
Practice Address - Fax:316-462-1042
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS53-75895363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily