Healthcare Provider Details

I. General information

NPI: 1629015029
Provider Name (Legal Business Name): EILEEN CALABRIA CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 BROADWAY BLVD FL 2
KANSAS CITY MO
64111-2659
US

IV. Provider business mailing address

2401 GILLHAM RD. PROVIDER ENROLLMENT
KANSAS CITY MO
64108-4619
US

V. Phone/Fax

Practice location:
  • Phone: 816-960-3090
  • Fax: 816-302-9931
Mailing address:
  • Phone: 816-701-5200
  • Fax: 816-302-9939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2000144402
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: