Provider Demographics
NPI:1477440972
Name:BERENDZEN, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BERENDZEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5607 W 81ST ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-4955
Mailing Address - Country:US
Mailing Address - Phone:573-645-4975
Mailing Address - Fax:
Practice Address - Street 1:4701 BAUER FARM DR STE B
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-8503
Practice Address - Country:US
Practice Address - Phone:785-838-5255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025009910363LF0000X
KS53-84475-052363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily