Healthcare Provider Details

I. General information

NPI: 1609835255
Provider Name (Legal Business Name): DEBBRA BERSANO CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1439 S MINTER WAY
GRAIN VALLEY MO
64029-9648
US

IV. Provider business mailing address

2310 HOLMES ST STE 800
KANSAS CITY MO
64108-2634
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-6785
  • Fax:
Mailing address:
  • Phone: 816-404-8188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number117508
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number117508
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: