MEDICARE: MANDY LUECK NP-C

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	2013004141	MO

General Provider Information

NPI Number	:	1619216678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANDY LUECK NP-C

Provider Business Mailing Address
First Line	:	6013 LEAVENWORTH RD
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66104-1436
Country	:	US
Telephone Number	:	913-321-2200
Fax Number	:

Provider Business Practice Location Address
First Line	:	6013 LEAVENWORTH RD
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66104-1436
Country	:	US
Telephone Number	:	913-321-2200
Fax Number	:

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

Provider Enumeration Date	:	02/11/2013
Last Update Date	:	02/05/2016

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