Provider Demographics
NPI:1790777977
Name:ULTZSCH, JANA E (CRNA)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:E
Last Name:ULTZSCH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JANA
Other - Middle Name:E
Other - Last Name:WHITEHAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2897
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-2897
Mailing Address - Country:US
Mailing Address - Phone:800-374-5326
Mailing Address - Fax:800-374-7656
Practice Address - Street 1:2770 N WEBB RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-8112
Practice Address - Country:US
Practice Address - Phone:800-374-5326
Practice Address - Fax:800-374-7656
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS54443207L00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100254500AMedicaid
KS100254500AMedicaid