Provider Demographics
NPI:1568419653
Name:DELACRUZ, NANCY ROSE (ARNP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ROSE
Last Name:DELACRUZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8901 W 74TH STREET
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66204
Mailing Address - Country:US
Mailing Address - Phone:913-831-2430
Mailing Address - Fax:913-831-0108
Practice Address - Street 1:8901 W 74TH STREET
Practice Address - Street 2:SUITE 120
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204
Practice Address - Country:US
Practice Address - Phone:913-831-2430
Practice Address - Fax:913-831-0108
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45769363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q54753Medicare UPIN
KS633E159Medicare PIN