Healthcare Provider Details

I. General information

NPI: 1780015404
Provider Name (Legal Business Name): NANETTE LANIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2013
Last Update Date: 12/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 E 68TH ST
KANSAS CITY MO
64131-1305
US

IV. Provider business mailing address

23921 W 293RD ST
PAOLA KS
66071-5712
US

V. Phone/Fax

Practice location:
  • Phone: 816-333-5485
  • Fax:
Mailing address:
  • Phone: 913-259-9677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number72757
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: