Healthcare Provider Details

I. General information

NPI: 1356581771
Provider Name (Legal Business Name): ROBIN WAYNE BANION CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2009
Last Update Date: 04/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11500 GRANADA ST
LEAWOOD KS
66211-1453
US

IV. Provider business mailing address

4801 S CLIFF AVE STE 100
INDEPENDENCE MO
64055-6954
US

V. Phone/Fax

Practice location:
  • Phone: 816-478-1230
  • Fax:
Mailing address:
  • Phone: 816-632-2101
  • Fax: 816-649-3383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2000144195
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: