Provider Demographics
NPI:1417725391
Name:VONGSENA, MANIPHAB (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:MANIPHAB
Middle Name:
Last Name:VONGSENA
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1261 N MAIZE RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-4302
Mailing Address - Country:US
Mailing Address - Phone:785-272-2631
Mailing Address - Fax:
Practice Address - Street 1:1261 N MAIZE RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-4302
Practice Address - Country:US
Practice Address - Phone:785-272-2631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1142373363LF0000X
KS53-82611-081363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily