1578614608 NPI number — MS. PAMELA ANN BEGLAU ANP

Table of content: MS. PAMELA ANN BEGLAU ANP (NPI 1578614608)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578614608 NPI number — MS. PAMELA ANN BEGLAU ANP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEGLAU
Provider First Name:
PAMELA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ANP
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:
1578614608
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19550 E 39TH ST S
Provider Second Line Business Mailing Address:
STE 245
Provider Business Mailing Address City Name:
INDEPENDENCE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64057-2303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-373-0655
Provider Business Mailing Address Fax Number:
816-478-6374

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19550 E 39TH ST S
Provider Second Line Business Practice Location Address:
STE 245
Provider Business Practice Location Address City Name:
INDEPENDENCE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64057-2303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-373-0655
Provider Business Practice Location Address Fax Number:
816-478-6374
Provider Enumeration Date:
01/16/2007

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: 363LA2200X , with the licence number:  088928 , 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: 710402 . This is a "MERCY CARE PLUS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 088928 . This is a "ANP LICENSE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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