Provider Demographics
NPI:1043391378
Name:PANKRATZ, DAWN M (CRNA)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:M
Last Name:PANKRATZ
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 843018
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3018
Mailing Address - Country:US
Mailing Address - Phone:913-782-2292
Mailing Address - Fax:913-782-2381
Practice Address - Street 1:20375 W 151ST ST
Practice Address - Street 2:SUITE 306
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-5306
Practice Address - Country:US
Practice Address - Phone:913-782-2292
Practice Address - Fax:913-782-2381
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1462812031163W00000X
KS54486367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100311600BMedicaid
KS430046796OtherRR MEDICARE
KS363000012Medicare PIN