Individual
MR. SCOTT MANWELL MCCORMICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2017 W HARBORLIGHT CT, WICHITA, KS 67204-2577
(316) 832-2331
(316) 755-1798
Mailing address
2017 W HARBORLIGHT CT, WICHITA, KS 67204-2577
(316) 832-2331
(316) 755-1798
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
13-39046-091
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100252460E
—
KS
01
—
144564
BLUE SHIELD
KS
Enumeration date
04/08/2006
Last updated
10/29/2020
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