Provider Demographics
NPI:1609366574
Name:FRY, LIANNA DAWN
Entity Type:Individual
Prefix:
First Name:LIANNA
Middle Name:DAWN
Last Name:FRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1947 E MARION RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67216-2251
Mailing Address - Country:US
Mailing Address - Phone:316-214-6262
Mailing Address - Fax:
Practice Address - Street 1:402 N MARKET ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-2012
Practice Address - Country:US
Practice Address - Phone:316-776-8173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator