Healthcare Provider Details

I. General information

NPI: 1851241806
Provider Name (Legal Business Name): WEGENE T BURAYU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2026
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 NW 69TH TER APT 7
KANSAS CITY MO
64151-2070
US

IV. Provider business mailing address

3501 NW 69TH TER APT 7
KANSAS CITY MO
64151-2070
US

V. Phone/Fax

Practice location:
  • Phone: 702-236-0480
  • Fax:
Mailing address:
  • Phone: 702-236-0480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberL1279393536
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: