Provider Demographics
NPI:1851483101
Name:VANDENDAELE, FAYE ELLEN (ARNP)
Entity Type:Individual
Prefix:
First Name:FAYE
Middle Name:ELLEN
Last Name:VANDENDAELE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:FAYE
Other - Middle Name:ELLEN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:10001 NE VROOMAN DR
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64161-9647
Mailing Address - Country:US
Mailing Address - Phone:816-454-9583
Mailing Address - Fax:612-659-7101
Practice Address - Street 1:8101 STATE AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-2421
Practice Address - Country:US
Practice Address - Phone:612-659-7111
Practice Address - Fax:612-659-7101
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45967363LF0000X
MO080187363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOX93000027Medicare UPIN
MOMA1521007Medicare PIN