Provider Demographics
NPI:1124094826
Name:HAFFNER, JUDITH (ARNP)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:
Last Name:HAFFNER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W CENTRAL AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-2184
Mailing Address - Country:US
Mailing Address - Phone:316-321-5630
Mailing Address - Fax:316-320-0244
Practice Address - Street 1:700 W CENTRAL AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-2184
Practice Address - Country:US
Practice Address - Phone:316-321-5630
Practice Address - Fax:316-320-0244
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44031363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS010536OtherKS BLUE CROSS/BLUE SHIELD
KS010536OtherKS BLUE CROSS/BLUE SHIELD
KSR31003Medicare UPIN