Provider Demographics
NPI:1508425141
Name:WADEL, EMILY ANN WESTERMAN (FNP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN WESTERMAN
Last Name:WADEL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17400 SW 110 AVE
Mailing Address - Street 2:
Mailing Address - City:ZENDA
Mailing Address - State:KS
Mailing Address - Zip Code:67159-9089
Mailing Address - Country:US
Mailing Address - Phone:620-243-2653
Mailing Address - Fax:
Practice Address - Street 1:200 W ROSS BLVD
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-7221
Practice Address - Country:US
Practice Address - Phone:620-371-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-07
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5378786032207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine