Basic Information
| Provider Information | |||||||||
| NPI: | 1992347876 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIAZ | ||||||||
| FirstName: | MOEID | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2630 W MULBERRY ST | ||||||||
| Address2: | |||||||||
| City: | OLATHE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660615017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136268488 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2340 E MEYER BLVD | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641321105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8169260777 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2019 | ||||||||
| LastUpdateDate: | 12/04/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 2019033715 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.