Healthcare Provider Details

I. General information

NPI: 1720884000
Provider Name (Legal Business Name): YOLANDE FRU RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 LINWOOD BLVD
KANSAS CITY MO
64128
US

IV. Provider business mailing address

4104 SW FLINTROCK DR
LEES SUMMIT MO
64082-4869
US

V. Phone/Fax

Practice location:
  • Phone: 816-861-4700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2019021357
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: