Provider Demographics
NPI:1679672257
Name:MANSFIELD, ROBERTA (APRN)
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:
Last Name:MANSFIELD
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 1:601 SW CORPORATE VW
Mailing Address - Street 2:STE 200
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66615-1244
Mailing Address - Country:US
Mailing Address - Phone:785-234-0880
Mailing Address - Fax:785-271-2220
Practice Address - Street 1:601 SW CORPORATE VW
Practice Address - Street 2:STE 200
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66615-1244
Practice Address - Country:US
Practice Address - Phone:785-234-0880
Practice Address - Fax:785-271-2220
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44508363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100285990CMedicaid
KS100285990CMedicaid
KS110918009Medicare PIN