Provider Demographics
NPI:1346595907
Name:VALDIVIA, NICOLE B (NP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:B
Last Name:VALDIVIA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 CLAY EDWARDS DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:N KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3251
Mailing Address - Country:US
Mailing Address - Phone:816-842-0171
Mailing Address - Fax:816-842-3582
Practice Address - Street 1:2700 CLAY EDWARDS DR
Practice Address - Street 2:SUITE 300
Practice Address - City:N KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3251
Practice Address - Country:US
Practice Address - Phone:816-842-0171
Practice Address - Fax:816-842-3582
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2012008571363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2012008571OtherANP LICENSE NUMBER