Provider Demographics
NPI:1700255734
Name:FARE, MARY CECILIA
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CECILIA
Last Name:FARE
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 1:1902 N 90TH ST
Mailing Address - Street 2:#207
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-1507
Mailing Address - Country:US
Mailing Address - Phone:913-633-0071
Mailing Address - Fax:
Practice Address - Street 1:1902 N 90TH ST
Practice Address - Street 2:#207
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-1507
Practice Address - Country:US
Practice Address - Phone:913-633-0071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS247200000X247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other