Provider Demographics
NPI:1043286750
Name:ORRICK, LISA I (PAC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:I
Last Name:ORRICK
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
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Mailing Address - Street 1:5330 N OAK TRAFFICWAY
Mailing Address - Street 2:STE 201
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118
Mailing Address - Country:US
Mailing Address - Phone:816-454-0666
Mailing Address - Fax:816-454-1694
Practice Address - Street 1:8800 W 75TH ST
Practice Address - Street 2:STE 140
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204
Practice Address - Country:US
Practice Address - Phone:913-722-5551
Practice Address - Fax:913-362-0583
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2011-09-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS1500933363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OTH000Medicare UPIN
KSG26C748AMedicare ID - Type Unspecified