Healthcare Provider Details

I. General information

NPI: 1508756693
Provider Name (Legal Business Name): DEJENET RAMBO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 E 30TH ST STE M3
KANSAS CITY MO
64109-1507
US

IV. Provider business mailing address

200 WESTPORT RD UNIT 45002
KANSAS CITY MO
64111-9998
US

V. Phone/Fax

Practice location:
  • Phone: 816-876-0281
  • Fax:
Mailing address:
  • Phone: 816-876-0281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: