Basic Information
Provider Information
NPI: 1982150082
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DOFFING
FirstName: MONICA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: A.P.R.N.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 929 N SAINT FRANCIS ST
Address2: EMERGENCY DEPARTMENT
City: WICHITA
State: KS
PostalCode: 672143821
CountryCode: US
TelephoneNumber: 3162685050
FaxNumber:  
Practice Location
Address1: 929 N SAINT FRANCIS ST
Address2:  
City: WICHITA
State: KS
PostalCode: 672143821
CountryCode: US
TelephoneNumber: 3162685000
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/29/2016
LastUpdateDate: 10/13/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X77349KSY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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