Provider Demographics
NPI:1376981357
Name:STANDER, BETSY J (APN)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:J
Last Name:STANDER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:J
Other - Last Name:PORTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4550 W 109TH ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1360
Mailing Address - Country:US
Mailing Address - Phone:913-307-3198
Mailing Address - Fax:
Practice Address - Street 1:4550 W 109TH ST
Practice Address - Street 2:SUITE 130
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1360
Practice Address - Country:US
Practice Address - Phone:913-307-3198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSTMP147024363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology