MEDICARE: MS. DANIELLE LEA CARMITCHEL APRN-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	363LP2300X	Primary Care Nurse Practitioner	53-80543-071	KS

General Provider Information

NPI Number	:	1912678996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DANIELLE LEA CARMITCHEL APRN-C

Provider Business Mailing Address
First Line	:	5422 HILLTOP DR
Second Line	:
City	:	SHAWNEE
State	:	KS
Zip	:	66226-2600
Country	:	US
Telephone Number	:	913-486-5189
Fax Number	:

Provider Business Practice Location Address
First Line	:	7450 KESSLER ST STE 300
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66204-2550
Country	:	US
Telephone Number	:	913-632-2900
Fax Number	:

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

Provider Enumeration Date	:	09/21/2021
Last Update Date	:	09/21/2021

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