Healthcare Provider Details

I. General information

NPI: 1609498492
Provider Name (Legal Business Name): MARCI RHEA CLINE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N WALNUT
CAMERON MO
64429
US

IV. Provider business mailing address

1600 E EVERGREEN ST
CAMERON MO
64429-2400
US

V. Phone/Fax

Practice location:
  • Phone: 816-632-2101
  • Fax:
Mailing address:
  • Phone: 660-635-0060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2020012804
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: