Provider Demographics
NPI:1801332564
Name:MOGOI, AMANDA LEANN (APRN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEANN
Last Name:MOGOI
Suffix:
Gender:F
Credentials:APRN
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 667
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-0667
Mailing Address - Country:US
Mailing Address - Phone:316-685-1206
Mailing Address - Fax:316-688-5208
Practice Address - Street 1:9300 E 29TH ST N STE 201
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2183
Practice Address - Country:US
Practice Address - Phone:316-685-1277
Practice Address - Fax:316-688-5208
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS77496363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner