Provider Demographics
NPI:1679263354
Name:RIOJAS-MACKEY, EVA NICOLE
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:NICOLE
Last Name:RIOJAS-MACKEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BROMAGEN
Other - Middle Name:NICOLE
Other - Last Name:EVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:49 TANGLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LA CYGNE
Mailing Address - State:KS
Mailing Address - Zip Code:66040-4236
Mailing Address - Country:US
Mailing Address - Phone:913-594-2542
Mailing Address - Fax:
Practice Address - Street 1:49 TANGLEWOOD LN
Practice Address - Street 2:
Practice Address - City:LA CYGNE
Practice Address - State:KS
Practice Address - Zip Code:66040-4236
Practice Address - Country:US
Practice Address - Phone:913-594-2542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician