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General NPI Number Information
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NPI Number | 1245599075
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Entity Type | Individual
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Provider Name | PEATRIC SAMBOL-GORDON RN,BSN,MBA,ACHA
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Gender | Female
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Dates
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Enumeration Date | 05/14/2012
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Last Update Date | 05/14/2012
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Provider Practice Location Address
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Address Line | 4646 SORTOR DR
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City | KANSAS CITY
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State | KS
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Zip | 66104-1253
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Country | US
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Telephone | 913-233-6247
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Fax |
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Provider Business Mailing Address
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Address Line | 4646 SORTOR DR
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City | KANSAS CITY
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State | KS
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Zip | 66104-1253
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Country | US
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Telephone | 913-233-6247
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1359686111
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 122895
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 163WA2000X
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Taxonomy Name | Administrator Registered Nurse
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License Number | 3450
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License Number State | KS
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