Healthcare Provider Details

I. General information

NPI: 1578682928
Provider Name (Legal Business Name): MUSUDEEN ANGEL HARRELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/03/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SW NOEL ST
LEES SUMMIT MO
64063-3810
US

IV. Provider business mailing address

300 SW NOEL ST
LEES SUMMIT MO
64063-3810
US

V. Phone/Fax

Practice location:
  • Phone: 816-678-8061
  • Fax: 816-774-4389
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number148064
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: