Basic Information
| Provider Information | |||||||||
| NPI: | 1689622417 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ENRIQUEZ | ||||||||
| FirstName: | MAITHE | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4601 W 109TH ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662111313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9139420540 | ||||||||
| FaxNumber: | 6305289589 | ||||||||
| Practice Location | |||||||||
| Address1: | 2340 E MEYER BLVD, BLDG 2 | ||||||||
| Address2: | SUITE 392 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 64132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164447977 | ||||||||
| FaxNumber: | 6305289578 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 01/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 086876 | MO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LA2200X | 086876 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.