Individual
MARY J DAGENAIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
9415 E HARRY ST STE 602, WICHITA, KS 67207-5082
(316) 681-2420
(316) 681-3561
Mailing address
9415 E HARRY ST STE 602, WICHITA, KS 67207-5082
(316) 681-2420
(316) 681-3561
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1218
OK
363A00000X
Physician Assistant
Primary
15-00874
KS
Other
Enumeration date
08/18/2005
Last updated
11/15/2024
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