MEDICARE: SARAH A UPDIKE CD(DONA), C.N.A.

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	376K00000X	Nurse's Aide	192761	KS
2	374J00000X	Doula

General Provider Information

NPI Number	:	1295073286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH A UPDIKE CD(DONA), C.N.A.

Provider Business Mailing Address
First Line	:	1319 N 69TH ST
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66102-3010
Country	:	US
Telephone Number	:	913-940-3030
Fax Number	:

Provider Business Practice Location Address
First Line	:	1319 N 69TH ST
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66102-3010
Country	:	US
Telephone Number	:	913-940-3030
Fax Number	:

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

Provider Enumeration Date	:	01/25/2013
Last Update Date	:	01/25/2013

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