Provider Demographics
NPI:1538820840
Name:CAMMISANO, LENAE SUZANNE (FNP-BC)
Entity type:Individual
Prefix:
First Name:LENAE
Middle Name:SUZANNE
Last Name:CAMMISANO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 SE STATE ROUTE 291 STE 101
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-4382
Mailing Address - Country:US
Mailing Address - Phone:816-510-8254
Mailing Address - Fax:
Practice Address - Street 1:620 SE STATE ROUTE 291 STE 101
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-4382
Practice Address - Country:US
Practice Address - Phone:816-510-8254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021186205363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily