Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 53-78242 | KS |
NPI | 1235622457 |
---|---|
Provider Name | Mrs. Elizabeth Lynette Bates |
First Address | Lenexa, KS 66220-4022 |
Second Address | Kansas City, KS 66160-8501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2018 |
Last Update Date | 12/06/2018 |