Individual
AMANDA GAIL DIVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE
Contact information
Practice address
8725 E 32ND ST N, WICHITA, KS 67226-4008
(316) 201-1202
(316) 201-1251
Mailing address
8725 E 32ND ST N, WICHITA, KS 67226-4008
(316) 201-1202
(316) 201-1251
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
2016013652
MO
363LP0200X
Pediatric Nurse Practitioner
Primary
53-78308-011
KS
Other
Enumeration date
07/06/2016
Last updated
03/11/2020
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