Provider Demographics
NPI:1508681149
Name:EXPRESS CARE & WELLNESS CLINIC LLC
Entity type:Organization
Organization Name:EXPRESS CARE & WELLNESS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:NGANGA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:913-207-9410
Mailing Address - Street 1:12599 S BELFORD ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7814
Mailing Address - Country:US
Mailing Address - Phone:913-201-9410
Mailing Address - Fax:
Practice Address - Street 1:12599 S BELFORD ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7814
Practice Address - Country:US
Practice Address - Phone:913-207-9410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No302R00000XManaged Care OrganizationsHealth Maintenance Organization