Individual
MRS. LESLIE POLK VAN DYKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
929 N SAINT FRANCIS AVE, WICHITA, KS 67214-3821
(316) 268-5000
Mailing address
1846 N CRANBROOK ST, WICHITA, KS 67206-8916
(903) 504-3376
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
53-45551-051
KS
363LA2100X
Acute Care Nurse Practitioner
R0114423
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200253540A
—
KS
01
—
8772NA
BCBS
TX
Enumeration date
06/17/2005
Last updated
08/07/2025
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