Provider Demographics
NPI:1891281655
Name:MUNSELL, KEIKO
Entity Type:Individual
Prefix:
First Name:KEIKO
Middle Name:
Last Name:MUNSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 SW HUNTOON ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-1231
Mailing Address - Country:US
Mailing Address - Phone:785-861-8800
Mailing Address - Fax:785-478-5991
Practice Address - Street 1:1400 SW HUNTOON ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-1231
Practice Address - Country:US
Practice Address - Phone:785-861-8800
Practice Address - Fax:785-478-5991
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-05
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS78143363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201204450BMedicaid