1992732556 NPI number — NICHOLE D VAN DUYNE D.O.

Table of content: NICHOLE D VAN DUYNE D.O. (NPI 1992732556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992732556 NPI number — NICHOLE D VAN DUYNE D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAN DUYNE
Provider First Name:
NICHOLE
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CLARK
Provider Other First Name:
NICHOLE
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992732556
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6420 PROSPECT AVE
Provider Second Line Business Mailing Address:
STE T-303
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64132-4147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-333-1919
Provider Business Mailing Address Fax Number:
816-333-2614

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6420 PROSPECT AVE
Provider Second Line Business Practice Location Address:
STE T-303
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64132-4147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-333-1919
Provider Business Practice Location Address Fax Number:
816-333-2614
Provider Enumeration Date:
06/27/2006

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: 207RP1001X , with the licence number:  2008026684 , 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)