Individual
MS. DIANE E WADDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
5514 CORPORATE DR STE 120, SAINT JOSEPH, MO 64507-7754
(816) 271-7169
Mailing address
5514 CORPORATE DR STE 120, SAINT JOSEPH, MO 64507-7754
(816) 271-7169
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
121001
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10001677501
COMMUNITY HEALTH PLAN
MO
05
—
200265100A
—
KS
05
—
201060639
—
MO
Enumeration date
07/08/2006
Last updated
03/17/2018
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