Individual
TINA WUTHNOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
720 MEDICAL CENTER DR, NEWTON, KS 67114-8778
(316) 284-5115
(316) 284-5110
Mailing address
PO BOX 8035, WICHITA, KS 67208-0035
(316) 689-9135
(316) 689-9102
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
00414
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042838
BCBS
KS
05
—
10039401B
—
KS
01
—
11106492
MULTIPLAN
KS
01
—
206484
HPK
KS
01
—
9686
PHS
KS
Enumeration date
08/07/2006
Last updated
07/16/2007
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