Healthcare Provider Details

I. General information

NPI: 1285996009
Provider Name (Legal Business Name): ANNE MARIE ONDAK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2012
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 NE SHOREVIEW CT
LEES SUMMIT MO
64064-1512
US

IV. Provider business mailing address

103 NE SHOREVIEW CT
LEES SUMMIT MO
64064-1512
US

V. Phone/Fax

Practice location:
  • Phone: 816-509-6280
  • Fax:
Mailing address:
  • Phone: 816-509-6280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number122020
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2012018405
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: