Healthcare Provider Details

I. General information

NPI: 1639974009
Provider Name (Legal Business Name): EVANGELINE ROSQUETA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 E LINWOOD BLVD
KANSAS CITY MO
64128-2226
US

IV. Provider business mailing address

20803 S SKYVIEW LN
SPRING HILL KS
66083-7558
US

V. Phone/Fax

Practice location:
  • Phone: 816-861-4700
  • Fax: 816-922-4838
Mailing address:
  • Phone: 913-645-3472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number1571286022
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: