Healthcare Provider Details

I. General information

NPI: 1518434299
Provider Name (Legal Business Name): STEPHANIE WARREN MAYER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2018
Last Update Date: 10/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14310 E 42ND ST S
INDEPENDENCE MO
64055-7308
US

IV. Provider business mailing address

14310 E 42ND ST S STE 600
INDEPENDENCE MO
64055-7308
US

V. Phone/Fax

Practice location:
  • Phone: 816-333-9200
  • Fax: 816-489-7499
Mailing address:
  • Phone: 816-333-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2018001599
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: