MEDICARE: DIANE MAHONEY ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	1999134650	MO

General Provider Information

NPI Number	:	1629058557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE MAHONEY ARNP

Provider Business Mailing Address
First Line	:	12801 W 138TH ST
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66221-4131
Country	:	US
Telephone Number	:	913-244-1080
Fax Number	:	913-402-7007

Provider Business Practice Location Address
First Line	:	12801 W 138TH ST
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66221-4131
Country	:	US
Telephone Number	:	913-244-1080
Fax Number	:	913-402-7007

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	01/30/2009

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