Provider Demographics
NPI:1194930990
Name:JIWANLAL, SHILOH S (ARNP)
Entity type:Individual
Prefix:MRS
First Name:SHILOH
Middle Name:S
Last Name:JIWANLAL
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 1:12128 E KILLENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-4124
Mailing Address - Country:US
Mailing Address - Phone:316-682-2212
Mailing Address - Fax:
Practice Address - Street 1:425 N TOPEKA ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-2413
Practice Address - Country:US
Practice Address - Phone:316-263-6941
Practice Address - Fax:316-263-5259
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-49131-062163W00000X
KS74209364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS161115OtherBCBS PROVIDER NUMBER
KS161115OtherBCBS PROVIDER NUMBER