Basic Information
| Provider Information | |||||||||
| NPI: | 1881926749 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BACKHAUS | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10540 MARTY ST | ||||||||
| Address2: | STE 100 | ||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662122551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136601616 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4700 INDIAN CREEK PKWY | ||||||||
| Address2: | |||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662074068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136601616 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2010 | ||||||||
| LastUpdateDate: | 08/24/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 53-75073-041 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LA2200X | 2009036280 | MO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.