Healthcare Provider Details

I. General information

NPI: 1356508246
Provider Name (Legal Business Name): ROBERT DEAN MCDAVITT RN BSN COCN CWCN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9908 N HEDGES AVE
KANSAS CITY MO
64157-9604
US

IV. Provider business mailing address

9908 N HEDGES AVE
KANSAS CITY MO
64157-9604
US

V. Phone/Fax

Practice location:
  • Phone: 816-415-8189
  • Fax:
Mailing address:
  • Phone: 816-415-8189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0900X
TaxonomyEnterostomal Therapy Registered Nurse
License Number136779
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number136779
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number136779
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code163WX1500X
TaxonomyOstomy Care Registered Nurse
License Number136779
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: