Individual
JACK ANDREW NIEDEREE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7111 E 21ST ST N, WICHITA, KS 67206-1090
(316) 684-2851
Mailing address
1010 N KANSAS ST, WICHITA, KS 67214-3124
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
07/14/2025
Last updated
07/14/2025
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