Individual
MS. LYDIA R RENICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3121 N WEBB RD, SUITE 101, WICHITA, KS 67226-8119
(316) 261-3130
(316) 261-3275
Mailing address
3121 N WEBB RD, SUITE 101, WICHITA, KS 67226-8119
(316) 261-3130
(316) 261-3275
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
15-01082
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200566420B
—
KS
Enumeration date
08/24/2007
Last updated
05/13/2021
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