MEDICARE: EILEEN CALABRIA CPNP

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	363LP0200X	Pediatric Nurse Practitioner	2000144402	MO

General Provider Information

NPI Number	:	1629015029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EILEEN CALABRIA CPNP

Provider Business Mailing Address
First Line	:	2401 GILLHAM RD.
Second Line	:	PROVIDER ENROLLMENT
City	:	KANSAS CITY
State	:	MO
Zip	:	64108-4619
Country	:	US
Telephone Number	:	816-701-5200
Fax Number	:	816-302-9939

Provider Business Practice Location Address
First Line	:	3101 BROADWAY BLVD FL 2
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-2659
Country	:	US
Telephone Number	:	816-960-3090
Fax Number	:	816-302-9931

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	10/30/2018

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