Healthcare Provider Details

I. General information

NPI: 1881926749
Provider Name (Legal Business Name): DIANE MARIE BACKHAUS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 INDIAN CREEK PKWY
OVERLAND PARK KS
66207-4068
US

IV. Provider business mailing address

10540 MARTY ST STE 100
OVERLAND PARK KS
66212-2551
US

V. Phone/Fax

Practice location:
  • Phone: 913-660-1616
  • Fax:
Mailing address:
  • Phone: 913-660-1616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number53-75073-041
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2009036280
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: