MEDICARE: LYDIA MARIEN 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	084189	MO

General Provider Information

NPI Number	:	1811934169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYDIA MARIEN FNP

Provider Business Mailing Address
First Line	:	6650 TROOST AVE
Second Line	:	SUITE 201
City	:	KANSAS CITY
State	:	MO
Zip	:	64131-1215
Country	:	US
Telephone Number	:	816-276-7600
Fax Number	:

Provider Business Practice Location Address
First Line	:	6650 TROOST AVE
Second Line	:	SUITE 201
City	:	KANSAS CITY
State	:	MO
Zip	:	64131-1215
Country	:	US
Telephone Number	:	816-276-7600
Fax Number	:

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	07/08/2007

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