Healthcare Provider Details

I. General information

NPI: 1740551076
Provider Name (Legal Business Name): COURTNEY ANN JUNE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2012
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 NE INDEPENDENCE AVE
LEES SUMMIT MO
64086-5544
US

IV. Provider business mailing address

901 NE INDEPENDENCE AVE
LEES SUMMIT MO
64086-5544
US

V. Phone/Fax

Practice location:
  • Phone: 816-347-3226
  • Fax: 816-246-8207
Mailing address:
  • Phone: 816-347-3226
  • Fax: 816-246-8207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number2006020707
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: