Provider Demographics
NPI:1336174820
Name:WAXMAN, NANCY R (MD)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:R
Last Name:WAXMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:ROTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10777 NALL AVE
Mailing Address - Street 2:#220
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1362
Mailing Address - Country:US
Mailing Address - Phone:913-469-0110
Mailing Address - Fax:913-469-6579
Practice Address - Street 1:10777 NALL AVE
Practice Address - Street 2:#220
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1362
Practice Address - Country:US
Practice Address - Phone:913-469-0110
Practice Address - Fax:913-469-6579
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0422772207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E08060Medicare UPIN
K285629Medicare ID - Type Unspecified