Individual
JACQUELINE E LEO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9390 E CENTRAL AVE STE 101, WICHITA, KS 67206-2565
(316) 733-4747
Mailing address
1402 S GOEBEL CIR, WICHITA, KS 67207-4006
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
53-78842-061
KS
Other
Enumeration date
08/21/2019
Last updated
08/21/2019
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