Provider Demographics
NPI:1497114482
Name:VANAUSDALL, STEPHANIE (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:VANAUSDALL
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10951 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-1331
Mailing Address - Country:US
Mailing Address - Phone:913-322-7408
Mailing Address - Fax:913-322-7410
Practice Address - Street 1:10951 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66219-1331
Practice Address - Country:US
Practice Address - Phone:913-322-7408
Practice Address - Fax:913-322-7410
Is Sole Proprietor?:No
Enumeration Date:2016-02-18
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016005316363LA2100X
KSTO BE ISSUED363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care