Healthcare Provider Details

I. General information

NPI: 1528449345
Provider Name (Legal Business Name): SHALAN MARIE STROUD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHALAN STAVENAU

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 06/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 WORNALL RD
KANSAS CITY MO
64111-3220
US

IV. Provider business mailing address

PO BOX 504407
SAINT LOUIS MO
63150-3220
US

V. Phone/Fax

Practice location:
  • Phone: 816-932-7940
  • Fax: 816-932-7957
Mailing address:
  • Phone: 816-502-7000
  • Fax: 816-932-7957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License Number2012022372
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: