MEDICARE: MRS. DOLLY CHERIAN FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	2005003493	MO

General Provider Information

NPI Number	:	1407180771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DOLLY CHERIAN FNP

Provider Business Mailing Address
First Line	:	1707 E 59TH TER
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64110-3549
Country	:	US
Telephone Number	:	816-522-9292
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 W. 11TH ST.
Second Line	:	STE. 1215
City	:	KANSAS CITY
State	:	MO
Zip	:	64108-1813
Country	:	US
Telephone Number	:	816-822-0050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2009
Last Update Date	:	09/29/2011

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