Provider Demographics
NPI:1396827267
Name:VANDENABEELE, CECIL A (PA)
Entity Type:Individual
Prefix:
First Name:CECIL
Middle Name:A
Last Name:VANDENABEELE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CECIL
Other - Middle Name:A
Other - Last Name:LAWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:20805 W 151ST ST STE 224
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7249
Mailing Address - Country:US
Mailing Address - Phone:913-782-8300
Mailing Address - Fax:913-782-1574
Practice Address - Street 1:20805 W 151ST ST STE 224
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7249
Practice Address - Country:US
Practice Address - Phone:913-782-8300
Practice Address - Fax:913-782-1574
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005003645363AM0700X
KS1501004363AM0700X
KS15-01004363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1396827267Medicaid
MOQ53604Medicare UPIN
MO1396827267Medicaid