Basic Information
| Provider Information | |||||||||
| NPI: | 1396377743 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUITSMAN | ||||||||
| FirstName: | CARMEN | ||||||||
| MiddleName: | RENEE | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15153 W 157TH TER | ||||||||
| Address2: | |||||||||
| City: | OLATHE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660623673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9137109434 | ||||||||
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| Practice Location | |||||||||
| Address1: | 23450 COLLEGE BLVD | ||||||||
| Address2: | |||||||||
| City: | OLATHE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660618702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9137647788 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2020 | ||||||||
| LastUpdateDate: | 03/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 13-119167-112 | KS | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 53-119167 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.