Individual
JORDAN TODD WIEDEMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
929 N SAINT FRANCIS AVE, WICHITA, KS 67214-3821
(316) 268-5000
(316) 291-4272
Mailing address
PO BOX 2897, WICHITA, KS 67201-2897
(844) 468-9498
(855) 630-1302
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
135451
KS
367500000X
Certified Registered Nurse Anesthetist
Primary
557837
KS
367500000X
Certified Registered Nurse Anesthetist
TMP159804
KS
Other
Enumeration date
07/31/2020
Last updated
01/18/2022
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