Individual
ANGELA DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
808 W MAPLE ST, WICHITA, KS 67213-5508
(316) 990-2574
Mailing address
808 W MAPLE ST, WICHITA, KS 67213-5508
(316) 990-2574
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200558500A
—
KS
Enumeration date
10/24/2013
Last updated
10/24/2013
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