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General NPI Number Information
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NPI Number | 1881129112
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Entity Type | Individual
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Provider Name | BROOKE DOUGAN
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Gender | Female
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Dates
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Enumeration Date | 04/24/2017
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Last Update Date | 10/26/2017
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Provider Practice Location Address
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Address Line | 3901 RAINBOW BLVD
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City | KANSAS CITY
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State | KS
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Zip | 66160-8500
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Country | US
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Telephone | 913-588-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 19786 JOHNSON ST
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City | STILWELL
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State | KS
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Zip | 66085-8717
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Country | US
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Telephone | 913-209-9983
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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 | 13115599031
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 43557490031
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 43-557490-031
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License Number State | KS
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