Provider Demographics
NPI:1427164128
Name:NEEDHAM-GAGNE, JANICE (ARNP)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:NEEDHAM-GAGNE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 STATE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66102-1281
Mailing Address - Country:US
Mailing Address - Phone:913-287-7800
Mailing Address - Fax:913-287-1112
Practice Address - Street 1:5701 STATE AVE STE 100
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-1281
Practice Address - Country:US
Practice Address - Phone:913-287-7800
Practice Address - Fax:913-287-1112
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45166363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP29441Medicare UPIN
KSH95B019Medicare ID - Type Unspecified