MEDICARE: MRS. NANCY JUNE UMSTED

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	174400000X	Specialist		MO

General Provider Information

NPI Number	:	1568513224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NANCY JUNE UMSTED

Provider Business Mailing Address
First Line	:	2109 SW BROOKSHIRE DR
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64015-7168
Country	:	US
Telephone Number	:	816-229-6138
Fax Number	:	816-229-8134

Provider Business Practice Location Address
First Line	:	2575 NE BARRY RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64155-2836
Country	:	US
Telephone Number	:	816-437-3711
Fax Number	:

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

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/08/2007

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