Provider Demographics
NPI:1013156736
Name:CREASSER, LORENE (ARNP)
Entity Type:Individual
Prefix:
First Name:LORENE
Middle Name:
Last Name:CREASSER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:CREASSER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9100 W 74TH ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66204-4004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:913-789-3106
Practice Address - Street 1:9100 W 74TH ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-4004
Practice Address - Country:US
Practice Address - Phone:913-676-2200
Practice Address - Fax:913-789-3106
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS46317363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200606620AMedicaid
KSP00722522OtherRR MEDICARE GROUP CG8899
KSP00722522OtherRR MEDICARE GROUP CG8899