Provider Demographics
NPI:1699224733
Name:STRAAYER, JENNIFER (LPN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:STRAAYER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 NE RICE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-5849
Mailing Address - Country:US
Mailing Address - Phone:816-600-0398
Mailing Address - Fax:
Practice Address - Street 1:1515 NE RICE RD
Practice Address - Street 2:SUITE A
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-5849
Practice Address - Country:US
Practice Address - Phone:816-600-0398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015037037164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2015037037Medicaid