Provider Demographics
NPI:1003807264
Name:MCENTEE, MARIE ELAINE (PA C)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:ELAINE
Last Name:MCENTEE
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 38
Mailing Address - Street 2:211 EAST EARL ST
Mailing Address - City:LEOTI
Mailing Address - State:KS
Mailing Address - Zip Code:67861-9504
Mailing Address - Country:US
Mailing Address - Phone:620-375-2233
Mailing Address - Fax:620-375-2646
Practice Address - Street 1:RR 2 BOX 38
Practice Address - Street 2:211 EAST EARL ST
Practice Address - City:LEOTI
Practice Address - State:KS
Practice Address - Zip Code:67861-9504
Practice Address - Country:US
Practice Address - Phone:620-375-2233
Practice Address - Fax:620-375-2646
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS15 00816363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS042782OtherBC BS
KS042782OtherBC BS
P41882Medicare UPIN