Provider Demographics
NPI:1710904255
Name:COULSON, ELAINE M, (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:M,
Last Name:COULSON
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:MS
Other - First Name:ELAINE
Other - Middle Name:MARIE
Other - Last Name:SOMMERHAUSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICIAN ASSISTANT
Mailing Address - Street 1:9415 E. HARRY
Mailing Address - Street 2:BUILDING 800
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207
Mailing Address - Country:US
Mailing Address - Phone:316-686-6303
Mailing Address - Fax:316-686-6764
Practice Address - Street 1:9415 E. HARRY
Practice Address - Street 2:BLDG 800
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207
Practice Address - Country:US
Practice Address - Phone:316-686-6303
Practice Address - Fax:316-686-6764
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1338469061163W00000X
KS1500532363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSS57633Medicare UPIN
S57633Medicare UPIN