Provider Demographics
NPI:1245575547
Name:AGA, MARIJEN SABAS (NP)
Entity Type:Individual
Prefix:
First Name:MARIJEN
Middle Name:SABAS
Last Name:AGA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E KANSAS ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:KS
Mailing Address - Zip Code:66043-1619
Mailing Address - Country:US
Mailing Address - Phone:913-727-3235
Mailing Address - Fax:
Practice Address - Street 1:6440 NIEMAN RD
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66203-3326
Practice Address - Country:US
Practice Address - Phone:913-826-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS91594163W00000X
KS5375539102363LA2200X
MO2015036177363LP0808X
KS75539363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201142710AMedicaid
MO420037115Medicaid