Individual
MANIPHAB VONGSENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, FNP-BC
Contact information
Practice address
1261 N MAIZE RD, WICHITA, KS 67212-4302
(785) 272-2631
Mailing address
1261 N MAIZE RD, WICHITA, KS 67212-4302
(785) 272-2631
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
1142373
TX
363LF0000X
Family Nurse Practitioner
Primary
53-82611-081
KS
Other
Enumeration date
12/19/2023
Last updated
10/08/2024
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