Individual
ANDREA MARIE JACK-MURDOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
224 E DOUGLAS AVE, SUITE 400, WICHITA, KS 67202-3423
(316) 264-1757
(316) 264-1907
Mailing address
PO BOX 2897, WICHITA, KS 67201-2897
(800) 374-5326
(800) 374-7656
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
55536
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
145392
BCBS OF KS
KS
05
—
200419150A
—
KS
01
—
P00398985
RR MEDICARE GROUP CQ2302
—
Enumeration date
11/08/2006
Last updated
02/06/2023
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