Individual
STEPHANIE NICOL TICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
929 N SAINT FRANCIS ST, WICHITA, KS 67214-3821
(316) 268-5000
Mailing address
PO BOX 2897, WICHITA, KS 67201-2897
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
118695
KS
367500000X
Certified Registered Nurse Anesthetist
Primary
557634
KS
Other
Enumeration date
06/04/2018
Last updated
09/28/2018
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