Provider Demographics
NPI:1891581039
Name:MALIWAT, KATHLEEN KATE SHANNE T
Entity type:Individual
Prefix:
First Name:KATHLEEN KATE SHANNE
Middle Name:T
Last Name:MALIWAT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4607 S EASTLAND CENTER DR APT 426
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-7805
Mailing Address - Country:US
Mailing Address - Phone:808-797-6099
Mailing Address - Fax:
Practice Address - Street 1:4607 S EASTLAND CENTER DR APT 426
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-7805
Practice Address - Country:US
Practice Address - Phone:808-797-6099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)