Provider Demographics
NPI:1649240938
Name:LAGO, HOLLY J (C-FNP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:J
Last Name:LAGO
Suffix:
Gender:F
Credentials:C-FNP
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:J
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:C-FNP
Mailing Address - Street 1:8101 PARALLEL PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-2067
Mailing Address - Country:US
Mailing Address - Phone:913-299-9200
Mailing Address - Fax:913-299-9210
Practice Address - Street 1:8101 PARALLEL PKWY STE 100
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-2067
Practice Address - Country:US
Practice Address - Phone:913-299-9200
Practice Address - Fax:913-299-9210
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR134082-4363L00000X
MO2020040251363LF0000X
KS80303363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
13620OtherAVERA
MN281G0KOOtherBLUE CROSS BLUE SHIELD
HP56828OtherHEALTHPARTNERS
47358OtherSANFORD HEALTH
IA0599456Medicaid
MN886467500Medicaid
974311045631OtherPREF ONE
MN435M6KOOtherBLUE CROSS BLUE SHIELD
806278OtherAMERICAS PPO
P00365643OtherRAILROAD MEDICARE
135445OtherUCARE
0121785OtherMEDICA
253254OtherMIDLANDS CHOICE
0121785OtherMEDICA
MN500003120Medicare PIN