Basic Information
Provider Information | |||||||||
NPI: | 1427481563 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SRNA | ||||||||
FirstName: | NICCI | ||||||||
MiddleName: | D | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 400 W 4TH ST STE 2 | ||||||||
Address2: |   | ||||||||
City: | MCPHERSON | ||||||||
State: | KS | ||||||||
PostalCode: | 674602306 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6202415500 | ||||||||
FaxNumber: | 6202416206 | ||||||||
Practice Location | |||||||||
Address1: | 400 W 4TH ST STE 2 | ||||||||
Address2: |   | ||||||||
City: | MCPHERSON | ||||||||
State: | KS | ||||||||
PostalCode: | 674602306 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6202415500 | ||||||||
FaxNumber: | 6202416206 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/13/2013 | ||||||||
LastUpdateDate: | 06/12/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 53-75981-052 | KS | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.