Healthcare Provider Details

I. General information

NPI: 1033414321
Provider Name (Legal Business Name): AMBER TIBERIO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBER STROUP

II. Dates (important events)

Enumeration Date: 01/18/2011
Last Update Date: 03/20/2022
Certification Date: 03/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6302 MONROVIA ST
SHAWNEE KS
66216-2740
US

IV. Provider business mailing address

15600 ALHAMBRA ST
OVERLAND PARK KS
66224-8734
US

V. Phone/Fax

Practice location:
  • Phone: 913-341-6767
  • Fax:
Mailing address:
  • Phone: 913-808-0956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number557002
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: