Healthcare Provider Details

I. General information

NPI: 1598037012
Provider Name (Legal Business Name): RACHEL LOIS GUNDERSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2012
Last Update Date: 10/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5210 N. BELT HIGHWAY
ST. JOSEPH MO
64506-1211
US

IV. Provider business mailing address

5210 N. BELT HIGHWAY
ST. JOSEPH MO
64506-1211
US

V. Phone/Fax

Practice location:
  • Phone: 816-271-1330
  • Fax: 816-271-1333
Mailing address:
  • Phone: 816-271-1330
  • Fax: 816-271-1333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2001028812
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: