Healthcare Provider Details

I. General information

NPI: 1174809941
Provider Name (Legal Business Name): ANUCIA SIVARATNAM JOSEPH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2011
Last Update Date: 10/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 LAMAR AVE SUITE 130
MISSION KS
66202-3234
US

IV. Provider business mailing address

6315 COOPER ST
SHAWNEE KS
66218-9222
US

V. Phone/Fax

Practice location:
  • Phone: 913-826-1537
  • Fax: 913-826-1594
Mailing address:
  • Phone: 913-568-4373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number261QM0801X
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1174513444
Identifier TypeOTHER
Identifier StateKS
Identifier IssuerJCMHC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: