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NPI Code Detail

MEDICARE: MRS. SANDRA MANN

MEDICARE: MRS. SANDRA MANN
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
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1063690188
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SANDRA MANN
Provider Business Mailing Address
First Line : 3309 SOUTHERN HILLS DR
Second Line :
City : KANSAS CITY
State : MO
Zip : 64137-2115
Country : US
Telephone Number : 816-966-9197
Fax Number :
Provider Business Practice Location Address
First Line : 3309 SOUTHERN HILLS DR
Second Line :
City : KANSAS CITY
State : MO
Zip : 64137-2115
Country : US
Telephone Number : 816-966-9197
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2008
Last Update Date : 01/31/2008

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