Provider Demographics
NPI:1376974386
Name:MALIWAT, JEANNE
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:MALIWAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:
Other - Last Name:COMBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RT, R, CT, M, BD
Mailing Address - Street 1:5005 PARK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-8319
Mailing Address - Country:US
Mailing Address - Phone:816-678-1449
Mailing Address - Fax:
Practice Address - Street 1:4801 E LINWOOD BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64128-2226
Practice Address - Country:US
Practice Address - Phone:816-861-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO279385247100000X, 2471B0102X, 2471C3401X, 2471C3402X, 2471M2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
No2471B0102XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistBone Densitometry
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
No2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammography