Healthcare Provider Details

I. General information

NPI: 1437661550
Provider Name (Legal Business Name): SAM MICHAEL SPANGLER RN, BSN, CCRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2017
Last Update Date: 10/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NE SAINT LUKES BLVD
LEES SUMMIT MO
64086-6000
US

IV. Provider business mailing address

304 NE CORDER ST
LEES SUMMIT MO
64063-2607
US

V. Phone/Fax

Practice location:
  • Phone: 816-287-6001
  • Fax:
Mailing address:
  • Phone: 417-766-2062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number2005024763
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number2005024763
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2019037100
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: