Provider Demographics
NPI:1205203411
Name:MAGWIRE, MELISSA LEE (RN CDE)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LEE
Last Name:MAGWIRE
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Gender:F
Credentials:RN CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8901 W 74TH ST
Mailing Address - Street 2:SUITE 269
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2204
Mailing Address - Country:US
Mailing Address - Phone:913-676-7585
Mailing Address - Fax:913-676-8189
Practice Address - Street 1:8901 W 74TH ST
Practice Address - Street 2:SUITE 269
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-2204
Practice Address - Country:US
Practice Address - Phone:913-676-7585
Practice Address - Fax:913-676-8189
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS13-58874-061163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator