Provider Demographics
NPI:1770684730
Name:LATHROP, ELLEN M (CRNA BSN MSNA)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:LATHROP
Suffix:
Gender:F
Credentials:CRNA BSN MSNA
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 411851
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64141-1851
Mailing Address - Country:US
Mailing Address - Phone:913-588-6670
Mailing Address - Fax:913-588-3365
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-8500
Practice Address - Country:US
Practice Address - Phone:913-588-6670
Practice Address - Fax:913-588-3365
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO138678367500000X
KS556865367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO917321200Medicaid
Q38681Medicare UPIN
MO917321200Medicaid