Healthcare Provider Details

I. General information

NPI: 1487708004
Provider Name (Legal Business Name): SYBLE JEAN CRETZMEYER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19550 E. 39TH ST. STE 300
INDEPENDENCE MO
64057-1855
US

IV. Provider business mailing address

19550 E. 39TH ST. STE 300
INDEPENDENCE MO
64057-1855
US

V. Phone/Fax

Practice location:
  • Phone: 816-478-0220
  • Fax: 816-795-3484
Mailing address:
  • Phone: 816-478-0220
  • Fax: 816-795-3484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number113738
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number113738
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: