Provider Demographics
NPI:1174307144
Name:ENVISION HEALTHCARE PROFESSIONAL SERVICES LLC
Entity type:Organization
Organization Name:ENVISION HEALTHCARE PROFESSIONAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:ABIGAEL
Authorized Official - Middle Name:OBONYO
Authorized Official - Last Name:MAKORI-MALINDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-548-6129
Mailing Address - Street 1:12974 S WIDMER ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-8814
Mailing Address - Country:US
Mailing Address - Phone:913-548-6129
Mailing Address - Fax:
Practice Address - Street 1:12974 S WIDMER ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-8814
Practice Address - Country:US
Practice Address - Phone:913-548-6129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service