Healthcare Provider Details

I. General information

NPI: 1053823682
Provider Name (Legal Business Name): CASSANDRA R FAGER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2017
Last Update Date: 11/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 BLUE RIDGE BLVD
KANSAS CITY MO
64138-4000
US

IV. Provider business mailing address

130 E WALDO AVE
INDEPENDENCE MO
64050-2987
US

V. Phone/Fax

Practice location:
  • Phone: 816-966-0903
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number2016722061
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: