Provider Demographics
NPI:1447476163
Name:BLINDAUER, NANCY ANN (PA)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ANN
Last Name:BLINDAUER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4930 NW 12TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-8609
Mailing Address - Country:US
Mailing Address - Phone:316-772-2992
Mailing Address - Fax:316-283-2968
Practice Address - Street 1:3425 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-4919
Practice Address - Country:US
Practice Address - Phone:316-772-2992
Practice Address - Fax:316-283-2968
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS1500040363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSB68615Medicare UPIN