Healthcare Provider Details

I. General information

NPI: 1942981105
Provider Name (Legal Business Name): AYALNESH G HAILE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14626 GRANDVIEW ST
OVERLAND PARK KS
66221-2217
US

IV. Provider business mailing address

14626 GRANDVIEW ST
OVERLAND PARK KS
66221-2217
US

V. Phone/Fax

Practice location:
  • Phone: 913-284-5979
  • Fax:
Mailing address:
  • Phone: 913-284-5979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number13-156851-021
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: