Provider Demographics
NPI:1588148944
Name:MASSMAN, ELIZABETH L
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:L
Last Name:MASSMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 W 83RD ST STE 254
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-5303
Mailing Address - Country:US
Mailing Address - Phone:913-291-0076
Mailing Address - Fax:913-951-0656
Practice Address - Street 1:4121 W 83RD ST STE 254
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-5303
Practice Address - Country:US
Practice Address - Phone:913-291-0076
Practice Address - Fax:913-951-0656
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-80642-062363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health