Provider Demographics
NPI:1932250859
Name:ANTONACCI, PAULA MARIE
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:MARIE
Last Name:ANTONACCI
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 1:9229 WARD PARKWAY
Mailing Address - Street 2:SUITE 225
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-3311
Mailing Address - Country:US
Mailing Address - Phone:816-537-0597
Mailing Address - Fax:
Practice Address - Street 1:9229 WARD PARKWAY
Practice Address - Street 2:SUITE 225
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-3311
Practice Address - Country:US
Practice Address - Phone:816-444-5511
Practice Address - Fax:816-822-8058
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001010244133V00000X
KS000038133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered