Healthcare Provider Details

I. General information

NPI: 1568137115
Provider Name (Legal Business Name): JULIE LYNN ZUKAITIS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2021
Last Update Date: 02/10/2022
Certification Date: 08/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11719 W 99TH PL
OVERLAND PARK KS
66214-2430
US

IV. Provider business mailing address

11719 W 99TH PL
OVERLAND PARK KS
66214-2430
US

V. Phone/Fax

Practice location:
  • Phone: 913-221-6057
  • Fax:
Mailing address:
  • Phone: 913-221-6057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5380014072
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: