Healthcare Provider Details

I. General information

NPI: 1497570642
Provider Name (Legal Business Name): WUNDER INTEGRATIVE HEALTH AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 OAK ST
BONNER SPRINGS KS
66012-1026
US

IV. Provider business mailing address

4049 PENNSYLVANIA AVE STE 203
KANSAS CITY MO
64111-3022
US

V. Phone/Fax

Practice location:
  • Phone: 816-667-6597
  • Fax:
Mailing address:
  • Phone: 816-667-6587
  • Fax: 816-379-3754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JESSICA WUNDER
Title or Position: NURSE PRACTITIONER
Credential: PMHNP
Phone: 402-216-8249