Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 13-021757-111 | KS |
NPI | 1104912518 |
---|---|
Provider Name | George Ann Eaks |
First Address | Kansas City, KS 66160 |
Second Address | Kansas City, KS 66160 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
520600 | FIRSTGUARD (01) | KS |
S77772 | (02) |