MEDICARE: ANJA ILEEN ISMERT

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	14-96867-032	KS
2	363LF0000X	Family Nurse Practitioner	125822	MO

General Provider Information

NPI Number	:	1427019660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANJA ILEEN ISMERT

Provider Business Mailing Address
First Line	:	PO BOX 219672
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64121-9672
Country	:	US
Telephone Number	:	816-628-4409
Fax Number	:	816-628-5783

Provider Business Practice Location Address
First Line	:	305 S PLATTE CLAY WAY
Second Line	:	STE A
City	:	KEARNEY
State	:	MO
Zip	:	64060-8214
Country	:	US
Telephone Number	:	816-628-4409
Fax Number	:	816-628-5783

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

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	09/25/2014

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Directions to “ ANJA ILEEN ISMERT ” Practice Location

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