| Organization Name: | 22 MDG |
| NPI Number: | 1275931263 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARINA PUENTES (FAMILY PRACTICE PHYSICIAN ASSISTANT) |
| Mailing Address: | 57950 Leavenworth St Mcconnell Afb |
| State: | KS US |
| Postal Code: | 672213506 |
| Phone Number: | 3167595019 |
| Fax Number: | |
| NPI Enumeration Date: | 12/08/2014 |
| NPI Last Update Date: | 12/08/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 286500000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Hospitals |
| Taxonomy Classification: | Military Hospital |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A health care facility operated by the Department of Defense. |