Provider Demographics
NPI:1356065494
Name:FROEHLICH, MALLOREE JO
Entity type:Individual
Prefix:
First Name:MALLOREE
Middle Name:JO
Last Name:FROEHLICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10408 N MCGEE ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-1740
Mailing Address - Country:US
Mailing Address - Phone:816-383-1887
Mailing Address - Fax:
Practice Address - Street 1:4179 STERLING AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64133-1348
Practice Address - Country:US
Practice Address - Phone:816-780-2870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-82063-112363L00000X
MO2022040708363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner