Provider Demographics
NPI:1013996487
Name:GUDENKAUF, GEORGIA M (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:GEORGIA
Middle Name:M
Last Name:GUDENKAUF
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 COMMUNITY DR
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:KS
Mailing Address - Zip Code:66538-9739
Mailing Address - Country:US
Mailing Address - Phone:785-336-6181
Mailing Address - Fax:785-336-3052
Practice Address - Street 1:201 N 6TH ST
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:KS
Practice Address - Zip Code:66538-1717
Practice Address - Country:US
Practice Address - Phone:785-336-6107
Practice Address - Fax:785-336-0157
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44336363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS160837OtherBCBS
KSS54735OtherGEORGIA M GUDENKAUF
KS160837OtherBCBS