Provider Demographics
NPI:1083960660
Name:RODENBERGER, ELLEN MARGUERITE
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARGUERITE
Last Name:RODENBERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 HUTTON RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66109-4526
Mailing Address - Country:US
Mailing Address - Phone:913-299-3700
Mailing Address - Fax:913-299-3050
Practice Address - Street 1:2040 HUTTON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66109-4526
Practice Address - Country:US
Practice Address - Phone:913-299-3700
Practice Address - Fax:913-299-3050
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS75717364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics