Provider Demographics
NPI:1770536682
Name:ENTZ, MAUREEN E (APRN, CPNP, C-NP)
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:E
Last Name:ENTZ
Suffix:
Gender:F
Credentials:APRN, CPNP, C-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 725
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-0725
Mailing Address - Country:US
Mailing Address - Phone:316-283-3627
Mailing Address - Fax:316-283-3635
Practice Address - Street 1:700 MEDICAL CENTER DR
Practice Address - Street 2:STE 150
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-9015
Practice Address - Country:US
Practice Address - Phone:316-283-7100
Practice Address - Fax:316-283-7118
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45760363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200367530CMedicaid
5589557OtherCOVENTRY / AETNA
KS161644Medicare ID - Type Unspecified