Provider Demographics
NPI:1548890072
Name:REINKEMEYER, MARY CELESTE (RN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CELESTE
Last Name:REINKEMEYER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:CELESTE
Other - Last Name:REINKEMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:POTTS
Mailing Address - Street 1:2000 W 97TH ST
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66206-2302
Mailing Address - Country:US
Mailing Address - Phone:913-669-6775
Mailing Address - Fax:
Practice Address - Street 1:2000 W 97TH ST
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66206-2302
Practice Address - Country:US
Practice Address - Phone:913-669-6775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-54685-121163W00000X
MO075737163W00000X
MOL-131909163WL0100X
KSL-131909163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse