Individual
TRAVIS ALAN JANUARY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
551 N HILLSIDE ST, WICHITA, KS 67214-4923
(316) 962-2623
Mailing address
551 N HILLSIDE ST, WICHITA, KS 67214-4923
(316) 962-2623
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
13-94085-041
KS
Other
Enumeration date
11/07/2012
Last updated
11/07/2012
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