Healthcare Provider Details

I. General information

NPI: 1477676526
Provider Name (Legal Business Name): ROSANNE E LYKKEN CRNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 CLAY EDWARDS DR SUITE 404
NORTH KANSAS CITY MO
64116-3237
US

IV. Provider business mailing address

2750 CLAY EDWARDS DR SUITE 404
NORTH KANSAS CITY MO
64116-3237
US

V. Phone/Fax

Practice location:
  • Phone: 816-472-9595
  • Fax: 816-472-0038
Mailing address:
  • Phone: 816-472-9595
  • Fax: 816-472-0038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number104737
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: