Provider Demographics
NPI:1801927389
Name:WIRTZ, MAUREEN A (APN)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:A
Last Name:WIRTZ
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 WASHINGTON
Mailing Address - Street 2:SUITE 500
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111
Mailing Address - Country:US
Mailing Address - Phone:816-756-0090
Mailing Address - Fax:816-756-0120
Practice Address - Street 1:4010 WASHINGTON
Practice Address - Street 2:SUITE 500
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111
Practice Address - Country:US
Practice Address - Phone:816-756-0090
Practice Address - Fax:816-756-0120
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO107806363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30366033OtherBC AND BS
KS30366033OtherBC AND BS
P83B911Medicare ID - Type Unspecified