Provider Demographics
NPI:1851492292
Name:VASQUEZ, RAYMOND LEE (FNP-C)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:LEE
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1741 NE DOUGLAS ST STE 102
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-4704
Mailing Address - Country:US
Mailing Address - Phone:816-525-6688
Mailing Address - Fax:877-673-4862
Practice Address - Street 1:1741 NE DOUGLAS ST STE 102
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-4704
Practice Address - Country:US
Practice Address - Phone:816-525-6688
Practice Address - Fax:877-673-4862
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005785111NI0900X
MO2015034087363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU17962Medicare UPIN
MOU17962Medicare UPIN