Provider Demographics
NPI:1689622417
Name:ENRIQUEZ, MAITHE (APRN)
Entity Type:Individual
Prefix:
First Name:MAITHE
Middle Name:
Last Name:ENRIQUEZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 W 109TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1313
Mailing Address - Country:US
Mailing Address - Phone:913-942-0540
Mailing Address - Fax:630-528-9589
Practice Address - Street 1:2340 E MEYER BLVD, BLDG 2
Practice Address - Street 2:SUITE 392
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132
Practice Address - Country:US
Practice Address - Phone:816-444-7977
Practice Address - Fax:630-528-9578
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO086876363LF0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO423821008Medicaid
MO2788076AMedicare Oscar/Certification