Healthcare Provider Details

I. General information

NPI: 1093065195
Provider Name (Legal Business Name): CARRIE LYNN MAURER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2012
Last Update Date: 09/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6226 HOLLIDAY DR
KANSAS CITY KS
66106-5350
US

IV. Provider business mailing address

6226 HOLLIDAY DR
KANSAS CITY KS
66106-5350
US

V. Phone/Fax

Practice location:
  • Phone: 913-549-6555
  • Fax:
Mailing address:
  • Phone: 913-549-6555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number13-97477-102
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: