1750350674 NPI number — NANCY ISRAEL MD

Table of content: NANCY ISRAEL MD (NPI 1750350674)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750350674 NPI number — NANCY ISRAEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ISRAEL
Provider First Name:
NANCY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750350674
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/01/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 23563
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHAWNEE MISSION
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66283-0563
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-248-9693
Provider Business Mailing Address Fax Number:
913-248-9383

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15144 PAWNEE CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEAWOOD
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66224-3832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-681-5871
Provider Business Practice Location Address Fax Number:
913-897-2166
Provider Enumeration Date:
03/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  105698 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 26642036 . This is a "BLUE SHIELD KANSAS CITY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: P00219297 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".