Healthcare Provider Details

I. General information

NPI: 1396827267
Provider Name (Legal Business Name): CECIL A VANDENABEELE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CECIL A LAWS PA

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 12/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20805 W 151ST ST STE 224
OLATHE KS
66061-7249
US

IV. Provider business mailing address

20805 W 151ST ST STE 224
OLATHE KS
66061-7249
US

V. Phone/Fax

Practice location:
  • Phone: 913-782-8300
  • Fax: 913-782-1574
Mailing address:
  • Phone: 913-782-8300
  • Fax: 913-782-1574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-01004
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2005003645
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1501004
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: