Provider Demographics
NPI:1467095174
Name:IBANEZ, TAMAR R (NP)
Entity Type:Individual
Prefix:
First Name:TAMAR
Middle Name:R
Last Name:IBANEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TAMAR
Other - Middle Name:
Other - Last Name:WOLKENFELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 E 104TH ST
Mailing Address - Street 2:MAILSTOP 400S
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-3220
Mailing Address - Country:US
Mailing Address - Phone:816-599-9261
Mailing Address - Fax:
Practice Address - Street 1:4330 WORNALL RD STE 2000
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5939
Practice Address - Country:US
Practice Address - Phone:816-931-1883
Practice Address - Fax:816-751-8635
Is Sole Proprietor?:No
Enumeration Date:2019-10-25
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019041346363LA2100X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care