Provider Demographics
NPI:1689338980
Name:DUSSELIER, MADELEINE (DNP, APRN, AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:
Last Name:DUSSELIER
Suffix:
Gender:F
Credentials:DNP, APRN, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2513 W 77TH ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-3808
Mailing Address - Country:US
Mailing Address - Phone:816-769-4943
Mailing Address - Fax:
Practice Address - Street 1:2513 W 77TH ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-3808
Practice Address - Country:US
Practice Address - Phone:816-769-4943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-25
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021042606363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner