1215084439 NPI number — DR. ANNE BERENBOM WISHNA MD

Table of content: DR. ANNE BERENBOM WISHNA MD (NPI 1215084439)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215084439 NPI number — DR. ANNE BERENBOM WISHNA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WISHNA
Provider First Name:
ANNE
Provider Middle Name:
BERENBOM
Provider Name Prefix Text:
DR.
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:
BERENBOM
Provider Other First Name:
ANNE
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215084439
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 219241
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64121-9241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-829-5511
Provider Business Mailing Address Fax Number:
913-829-5571

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4000 CAMBRIDGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66160-7200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-588-1227
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/03/2007

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: 207W00000X , with the licence number:  240818 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 04-34367 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200678210A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00860901 . This is a "RR MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".