Individual
MRS. ANGELA L DODGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
929 N SAINT FRANCIS ST, WICHITA, KS 67214-3821
(316) 268-5775
(316) 291-7496
Mailing address
PO BOX 47222, WICHITA, KS 67201-7222
(316) 268-8131
(316) 291-4788
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
139521322
KS
363L00000X
Nurse Practitioner
Primary
46215
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110990010
MEDICARE
KS
05
—
200567260A
—
KS
Enumeration date
07/23/2008
Last updated
11/30/2010
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