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General NPI Number Information
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NPI Number | 1821002437
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Entity Type | Individual
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Provider Name | BESSIE DETEL RTRM
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Gender | Female
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 825 EUCLID AVE
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City | KANSAS CITY
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State | MO
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Zip | 64124-2323
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Country | US
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Telephone | 816-474-4920
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Fax | 816-474-4914
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Provider Business Mailing Address
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Address Line | 1705 SE BLUEJAY DR
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City | BLUE SPRINGS
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State | MO
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Zip | 64014-6238
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Country | US
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Telephone | 816-474-4920
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Fax | 816-474-4914
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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 | 2471M2300X
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Taxonomy Name | Mammography Radiologic Technologist
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License Number | 281339
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License Number State | MO
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