Provider Demographics
NPI:1386695005
Name:BALFANZ, LUISE AUGUSTA (CRNA)
Entity type:Individual
Prefix:
First Name:LUISE
Middle Name:AUGUSTA
Last Name:BALFANZ
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LUISE
Other - Middle Name:AUGUSTA
Other - Last Name:BALFALNZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:2700 CLAY EDWARDS DR STE 240
Mailing Address - Street 2:
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3254
Mailing Address - Country:US
Mailing Address - Phone:816-691-2021
Mailing Address - Fax:816-346-7690
Practice Address - Street 1:2700 CLAY EDWARDS DR STE 240
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3254
Practice Address - Country:US
Practice Address - Phone:816-691-2021
Practice Address - Fax:816-346-7690
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2019-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS54943367500000X
MO098620367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP00982348OtherRAILROAD MEDICARE PTAN
MOP01026702OtherRAILROAD MEDICARE PTAN
MO915291215Medicaid
KS100393220BMedicaid
KS110017031Medicare PIN
MOW49000008Medicare PIN
KS100393220BMedicaid