Healthcare Provider Details

I. General information

NPI: 1811968035
Provider Name (Legal Business Name): NICOLLE MARIE GUNTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 W 119TH ST STE. 220
OVERLAND PARK KS
66209-3721
US

IV. Provider business mailing address

5701 W 119TH ST STE. 220
OVERLAND PARK KS
66209-3721
US

V. Phone/Fax

Practice location:
  • Phone: 913-498-8787
  • Fax: 913-498-1744
Mailing address:
  • Phone: 913-498-8787
  • Fax: 913-498-1744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2001013785
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number04-29722
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number2001013785
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2001013785
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04-29722
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: