Individual
SHAD FORESIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2200 SW GAGE BLVD, TOPEKA, KS 66620-0001
(785) 350-3111
Mailing address
PO BOX 4073, TOPEKA, KS 66604-0073
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
150373
KS
Other
Enumeration date
01/19/2024
Last updated
01/19/2024
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