Provider Demographics
NPI:1821767450
Name:WIEBE, ELIZABETH G (FNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:G
Last Name:WIEBE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 S 42ND ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66106-1952
Mailing Address - Country:US
Mailing Address - Phone:913-831-1100
Mailing Address - Fax:913-831-0827
Practice Address - Street 1:1420 S 42ND ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66106
Practice Address - Country:US
Practice Address - Phone:913-831-1100
Practice Address - Fax:913-831-0827
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021002517363LP2300X
KS53-80454-012363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care