Provider Demographics
NPI:1336982099
Name:ADELHARDT, RAELYNN
Entity type:Individual
Prefix:
First Name:RAELYNN
Middle Name:
Last Name:ADELHARDT
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 1:15015 W SELMA ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67227-7729
Mailing Address - Country:US
Mailing Address - Phone:620-243-3119
Mailing Address - Fax:
Practice Address - Street 1:15015 W SELMA ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67227-7729
Practice Address - Country:US
Practice Address - Phone:620-243-3119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Q00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Pathology