Provider Demographics
NPI:1336171701
Name:BRECHEISEN, NANCY L (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:L
Last Name:BRECHEISEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5301 FARAON ST STE 210A
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-3512
Mailing Address - Country:US
Mailing Address - Phone:816-271-1385
Mailing Address - Fax:816-271-1379
Practice Address - Street 1:5301 FARAON ST
Practice Address - Street 2:SUITE 210
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3373
Practice Address - Country:US
Practice Address - Phone:816-271-1385
Practice Address - Fax:816-271-1379
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002010567207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205865009Medicaid
KS100422680AMedicaid
KS102471Medicare ID - Type Unspecified
MO290014749Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MOG70562Medicare UPIN
MO205865009Medicaid