Provider Demographics
NPI:1790417681
Name:DUMMERMUTH, VIRIDIANA MADRID (DNP, APRN, FBP-BC)
Entity Type:Individual
Prefix:
First Name:VIRIDIANA
Middle Name:MADRID
Last Name:DUMMERMUTH
Suffix:
Gender:F
Credentials:DNP, APRN, FBP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTT CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67871-1601
Mailing Address - Country:US
Mailing Address - Phone:620-214-2303
Mailing Address - Fax:
Practice Address - Street 1:212 E 5TH ST
Practice Address - Street 2:
Practice Address - City:SCOTT CITY
Practice Address - State:KS
Practice Address - Zip Code:67871-1601
Practice Address - Country:US
Practice Address - Phone:620-214-2303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-81332-022363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily