Individual
MARVIN PAMATMAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2610 N WOODLAWN ST, WICHITA, KS 67220-2729
(316) 858-2610
Mailing address
PO BOX 3374, WICHITA, KS 67201-3374
(316) 685-6236
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
54504
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
145043
BCBS
KS
Enumeration date
03/14/2006
Last updated
09/13/2007
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