Healthcare Provider Details

I. General information

NPI: 1346212586
Provider Name (Legal Business Name): MARY E WINTER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 10/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 FREDERICK AVE
SAINT JOSEPH MO
64506-3238
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 816-364-9992
  • Fax:
Mailing address:
  • Phone: 913-721-3641
  • Fax: 913-721-3649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number105850
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: