Provider Demographics
NPI:1831514660
Name:MUTTAI, LYDIA (APRN)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:MUTTAI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11661 COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-4107
Mailing Address - Country:US
Mailing Address - Phone:913-432-8400
Mailing Address - Fax:913-432-8402
Practice Address - Street 1:11661 COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-4107
Practice Address - Country:US
Practice Address - Phone:913-432-8400
Practice Address - Fax:913-432-8402
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS76272363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health