Provider Demographics
NPI:1609843515
Name:PFANNENSTIEL, SUSAN K (APRN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:PFANNENSTIEL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4910 W 1ST ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-2341
Mailing Address - Country:US
Mailing Address - Phone:316-866-2075
Mailing Address - Fax:
Practice Address - Street 1:4910 W 1ST ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-2341
Practice Address - Country:US
Practice Address - Phone:316-866-2075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45207363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100400060AMedicaid
KS100400060AMedicaid
KS160674Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #