Provider Demographics
NPI:1245633916
Name:KINTU, MARIA (LPN,BSA)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:
Last Name:KINTU
Suffix:
Gender:F
Credentials:LPN,BSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12316 W 79TH TERR
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215
Mailing Address - Country:US
Mailing Address - Phone:913-416-3289
Mailing Address - Fax:
Practice Address - Street 1:12316 W 79TH TERR
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215
Practice Address - Country:US
Practice Address - Phone:913-416-3289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-41914-122IV164W00000X, 364SH0200X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome Health