Provider Demographics
NPI:1447209879
Name:MARAK, DIANNA LYNN (ARNPC)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:LYNN
Last Name:MARAK
Suffix:
Gender:F
Credentials:ARNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20805 W 151ST ST STE 400
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:913-780-4900
Mailing Address - Fax:
Practice Address - Street 1:20805 W 151ST ST STE 400
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:913-780-4900
Practice Address - Fax:913-780-0949
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105747363LF0000X
KS45060363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS160549OtherBC/BS KS OUTREACH CLINICS
KS100376280AMedicaid
MO100376280BMedicaid
MO29921019OtherBCBS KC
KS160549Medicare PIN
KSP18070Medicare UPIN
KS500023375Medicare PIN
KS100376280AMedicaid
MO500023377Medicare PIN
KS500023372Medicare PIN
KS038A740BMedicare PIN
MO500023376Medicare PIN