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General NPI Number Information
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NPI Number | 1740232578
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Entity Type | Individual
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Provider Name | AMBER LEA WOLLESEN M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 11/26/2019
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Provider Practice Location Address
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Address Line | 9229 WARD PKWY STE 380
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City | KANSAS CITY
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State | MO
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Zip | 64114-5471
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Country | US
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Telephone | 816-319-4785
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Fax |
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Provider Business Mailing Address
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Address Line | 901 E 104TH ST
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City | KANSAS CITY
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State | MO
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Zip | 64131-4517
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Country | US
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Telephone | 816-502-8782
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Fax | 816-932-9670
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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 | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number | 2006008025
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License Number State | MO
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