Provider Demographics
NPI:1124131610
Name:WETMORE, ELIZABETH B (ARNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:B
Last Name:WETMORE
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 1:300 CUSTER ST
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-0848
Mailing Address - Country:US
Mailing Address - Phone:620-225-3727
Mailing Address - Fax:620-225-2689
Practice Address - Street 1:300 CUSTER ST
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-0848
Practice Address - Country:US
Practice Address - Phone:620-225-3727
Practice Address - Fax:620-225-2689
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44332207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100361000BMedicaid
KS171000Medicare ID - Type UnspecifiedGROUP MEDICARE ID
KS161586Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #
KS100361000BMedicaid