Provider Demographics
NPI:1558721837
Name:INFANT EAR SHAPING
Entity Type:Organization
Organization Name:INFANT EAR SHAPING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SEBES
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:316-573-9228
Mailing Address - Street 1:4545 N RUSHWOOD CT
Mailing Address - Street 2:
Mailing Address - City:BEL AIRE
Mailing Address - State:KS
Mailing Address - Zip Code:67226-1478
Mailing Address - Country:US
Mailing Address - Phone:316-573-9228
Mailing Address - Fax:
Practice Address - Street 1:4545 N RUSHWOOD CT
Practice Address - Street 2:
Practice Address - City:BEL AIRE
Practice Address - State:KS
Practice Address - Zip Code:67226-1478
Practice Address - Country:US
Practice Address - Phone:316-573-9228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty