Healthcare Provider Details

I. General information

NPI: 1982989281
Provider Name (Legal Business Name): SUSAN GATROST APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2011
Last Update Date: 10/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 N OLD TWYMAN RD
INDEPENDENCE MO
64058-2294
US

IV. Provider business mailing address

2400 N OLD TWYMAN RD
INDEPENDENCE MO
64058-2294
US

V. Phone/Fax

Practice location:
  • Phone: 816-650-6856
  • Fax: 816-650-6856
Mailing address:
  • Phone: 816-650-6856
  • Fax: 816-650-6856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number058915
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number14-83058-052
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number058915
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: