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Organization
22 MDG
Active
Organization
22 MDG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARINA PUENTES PA (FAMILY PRACTICE PHYSICIAN ASSISTANT)
(316) 759-5019
Entity
Organization
Contact information
Practice address
57950 LEAVENWORTH ST, MCCONNELL AFB, KS 67221-3506
(316) 759-5019
Mailing address
57950 LEAVENWORTH ST, MCCONNELL AFB, KS 67221-3506
Taxonomy
Speciality
Code
Description
License number
State
286500000X
Military Hospital
Primary
—
—
Other
Enumeration date
12/08/2014
Last updated
12/08/2014
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