Healthcare Provider Details

I. General information

NPI: 1750976072
Provider Name (Legal Business Name): GENARO OLMEDO II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 E SANTA FE ST
OLATHE KS
66061-3448
US

IV. Provider business mailing address

540 E SANTA FE ST
OLATHE KS
66061-3448
US

V. Phone/Fax

Practice location:
  • Phone: 816-536-5327
  • Fax:
Mailing address:
  • Phone: 816-536-5327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2020018076
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: