Provider Demographics
NPI:1366962003
Name:NYANCHINI, EMMANUEL H
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:H
Last Name:NYANCHINI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NONE
Other - Middle Name:NONE
Other - Last Name:NONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1100 S ROYAL ROAD
Mailing Address - Street 2:1100 S ROYAL ROAD
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-2840
Mailing Address - Country:US
Mailing Address - Phone:316-821-8639
Mailing Address - Fax:316-613-8059
Practice Address - Street 1:1100 S ROYAL ROAD
Practice Address - Street 2:1100 S ROYAL ROAD
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-2840
Practice Address - Country:US
Practice Address - Phone:318-821-8639
Practice Address - Fax:316-613-8059
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-23
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS036-820900399F-01343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS036-820900399F-01OtherKANSAS WITH HOLDING TAX IDENTIFICATION NUMBER/ACCOUNT