Healthcare Provider Details

I. General information

NPI: 1760735344
Provider Name (Legal Business Name): SHEENA M CRISWELL C.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2012
Last Update Date: 10/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9710 E US HIGHWAY 40
INDEPENDENCE MO
64055-6116
US

IV. Provider business mailing address

11204 MYRTLE AVE
KANSAS CITY MO
64137-2311
US

V. Phone/Fax

Practice location:
  • Phone: 816-313-6163
  • Fax: 816-313-1232
Mailing address:
  • Phone: 530-949-0692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number12080012
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: