Healthcare Provider Details

I. General information

NPI: 1710145099
Provider Name (Legal Business Name): TANYA MCCREA NIELSEN MS CCCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TANYA MCCREA GROPPE MS CCCA

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 11/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 GLENN HENDREN DR STE 104
LIBERTY MO
64068-3388
US

IV. Provider business mailing address

PO BOX 219672
KANSAS CITY MO
64121-9672
US

V. Phone/Fax

Practice location:
  • Phone: 816-781-6066
  • Fax: 816-792-0408
Mailing address:
  • Phone: 816-407-4200
  • Fax: 816-407-2362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number051
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2019044094
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: