Provider Demographics
NPI:1689604555
Name:ARENSDORF, NICOLE Z (MD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:Z
Last Name:ARENSDORF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8020 E CENTRAL AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2360
Mailing Address - Country:US
Mailing Address - Phone:316-636-2662
Mailing Address - Fax:316-636-2685
Practice Address - Street 1:8020 E CENTRAL AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2360
Practice Address - Country:US
Practice Address - Phone:316-636-2662
Practice Address - Fax:316-636-2685
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS030934207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200271190CMedicaid
KS200271190CMedicaid