Provider Demographics
NPI:1427049451
Name:AHLSTROM, LAURA (PA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:AHLSTROM
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:6420 PROSPECT AVENUE
Mailing Address - Street 2:SUITE T101
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64132-1186
Mailing Address - Country:US
Mailing Address - Phone:816-363-4100
Mailing Address - Fax:816-363-8201
Practice Address - Street 1:5701 W 119TH ST
Practice Address - Street 2:SUITE 330
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-3722
Practice Address - Country:US
Practice Address - Phone:913-451-8500
Practice Address - Fax:913-451-1754
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2005008902363AM0700X
KS1014363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP03563Medicare UPIN