Provider Demographics
NPI:1629058557
Name:MAHONEY, DIANE (ARNP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:MAHONEY
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 1:12801 W 138TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66221-4131
Mailing Address - Country:US
Mailing Address - Phone:913-244-1080
Mailing Address - Fax:913-402-7007
Practice Address - Street 1:12801 W 138TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66221-4131
Practice Address - Country:US
Practice Address - Phone:913-244-1080
Practice Address - Fax:913-402-7007
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999134650363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner