Provider Demographics
NPI:1427371319
Name:MANDACINA, ANNAMARIE (RN ANP-BC)
Entity Type:Individual
Prefix:MS
First Name:ANNAMARIE
Middle Name:
Last Name:MANDACINA
Suffix:
Gender:F
Credentials:RN ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4812 NE 62ND ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64119-5065
Mailing Address - Country:US
Mailing Address - Phone:816-453-4996
Mailing Address - Fax:
Practice Address - Street 1:4320 WORNALL RD
Practice Address - Street 2:SUITE 50
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5941
Practice Address - Country:US
Practice Address - Phone:816-931-3312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO143415363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health