Provider Demographics
NPI:1891747226
Name:AIYENOWO, ROSE NDULULU (ARNP)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:NDULULU
Last Name:AIYENOWO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:NDULULU
Other - Last Name:KIANDIKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1883 W 21ST ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-2104
Mailing Address - Country:US
Mailing Address - Phone:316-832-0277
Mailing Address - Fax:316-838-5658
Practice Address - Street 1:1883 W 21ST ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-2104
Practice Address - Country:US
Practice Address - Phone:316-832-0277
Practice Address - Fax:316-838-5658
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS74139363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110839Medicare ID - Type UnspecifiedGROUP PROVIDER ID