Healthcare Provider Details

I. General information

NPI: 1043299969
Provider Name (Legal Business Name): MARY M LUDER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 05/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 W 106TH STREET SUITE 130
OVERLAND PARK KS
66215-2305
US

IV. Provider business mailing address

12200 W 106TH ST SUITE 130
OVERLAND PARK KS
66215-2305
US

V. Phone/Fax

Practice location:
  • Phone: 913-307-0044
  • Fax: 913-227-0094
Mailing address:
  • Phone: 913-307-0044
  • Fax: 913-227-0094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SW0102X
TaxonomyWomen's Health Clinical Nurse Specialist
License Number1369011062
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code364SW0102X
TaxonomyWomen's Health Clinical Nurse Specialist
License NumberNP45665
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code364SW0102X
TaxonomyWomen's Health Clinical Nurse Specialist
License Number135783
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: