MEDICARE: DONNA REX RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	083106	MO
2	163W00000X	Registered Nurse	14-77078-031	KS

General Provider Information

NPI Number	:	1013324755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA REX RN

Provider Business Mailing Address
First Line	:	1141 SW TRAIL RIDGE DR
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64015-1805
Country	:	US
Telephone Number	:	816-304-1940
Fax Number	:

Provider Business Practice Location Address
First Line	:	1141 SW TRAIL RIDGE DR
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64015-1805
Country	:	US
Telephone Number	:	816-304-1940
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2014
Last Update Date	:	07/15/2014

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