Healthcare Provider Details

I. General information

NPI: 1982633962
Provider Name (Legal Business Name): ELVIRA CONSTANTINO TABIJE CRNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELVIE CONSTANTINO TABIJE CRNFA

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 CARONDELET DR
KANSAS CITY MO
64114-4673
US

IV. Provider business mailing address

4 W BRIDLESPUR TER
KANSAS CITY MO
64114-5066
US

V. Phone/Fax

Practice location:
  • Phone: 816-943-2612
  • Fax: 816-943-4658
Mailing address:
  • Phone: 816-941-7404
  • Fax: 816-941-7404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number070795
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: