Individual
MICHELLE VAN DER WEGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
522 BROADWAY ST, LARNED, KS 67550-3042
(620) 804-6100
(620) 804-6055
Mailing address
1905 19TH ST, GREAT BEND, KS 67530-2502
(620) 792-5700
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
77268
KS
Other
Enumeration date
06/16/2016
Last updated
07/30/2024
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