Healthcare Provider Details

I. General information

NPI: 1902714132
Provider Name (Legal Business Name): BAOWENDSOM MAGALIE SUZELE ZOUNGRANA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2026
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 W 30TH ST
JOPLIN MO
64804-1603
US

IV. Provider business mailing address

1711 W 30TH ST
JOPLIN MO
64804-1603
US

V. Phone/Fax

Practice location:
  • Phone: 352-213-7549
  • Fax:
Mailing address:
  • Phone: 352-213-7549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: