Provider Demographics
NPI:1114668027
Name:WARENGO, MADELINE
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:WARENGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 FAIRMOUNT ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67260-9700
Mailing Address - Country:US
Mailing Address - Phone:623-640-4383
Mailing Address - Fax:
Practice Address - Street 1:1845 FAIRMOUNT ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67260-2744
Practice Address - Country:US
Practice Address - Phone:316-978-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2024-08-01
Deactivation Date:2022-07-29
Deactivation Code:
Reactivation Date:2024-08-01
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer