Provider Demographics
NPI:1952315251
Name:MAIER, MARILYN J (APRN CNM)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:J
Last Name:MAIER
Suffix:
Gender:F
Credentials:APRN CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64124-2323
Mailing Address - Country:US
Mailing Address - Phone:816-474-4920
Mailing Address - Fax:816-474-4914
Practice Address - Street 1:825 EUCLID AVENUE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64124-2323
Practice Address - Country:US
Practice Address - Phone:816-474-4920
Practice Address - Fax:816-474-4914
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000159661367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOC16A987OtherMEDICARE B WHEATLANDS
MO255125007Medicaid
S95134Medicare UPIN