Healthcare Provider Details

I. General information

NPI: 1467482810
Provider Name (Legal Business Name): MARC ANTONY TREGNAGO RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8809 NE 75TH ST
KANSAS CITY MO
64158-1047
US

IV. Provider business mailing address

8809 NE 75TH ST
KANSAS CITY MO
64158-1047
US

V. Phone/Fax

Practice location:
  • Phone: 816-792-2960
  • Fax:
Mailing address:
  • Phone: 816-792-2960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC3500X
TaxonomyCardiac Rehabilitation Registered Nurse
License Number131110
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: