Individual
NICCI D SRNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1100 N 4TH ST, LEAVENWORTH, KS 66048-1572
(913) 297-9945
Mailing address
4055 E LAPSLEY RD, ASSARIA, KS 67416-8746
(785) 632-7033
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
53-75981-052
KS
Other
Enumeration date
08/13/2013
Last updated
04/12/2023
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