Healthcare Provider Details

I. General information

NPI: 1114900172
Provider Name (Legal Business Name): CONSTANCE L ROGERS RN ARNP CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CONSTANCE L HARNISH

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 10/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 WOLLARD BLVD
RICHMOND MO
64085-2229
US

IV. Provider business mailing address

3705 N 139TH ST
KANSAS CITY KS
66109-4234
US

V. Phone/Fax

Practice location:
  • Phone: 816-470-5432
  • Fax:
Mailing address:
  • Phone: 913-721-3641
  • Fax: 913-721-3649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number062971
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number062971
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: