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General NPI Number Information
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NPI Number | 1881745131
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Entity Type | Individual
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Provider Name | MARY ALLISON WETZEL CRNA
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Gender | Female
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 02/08/2018
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Provider Practice Location Address
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Address Line | 603 E GAINES DR
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City | CLINTON
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State | MO
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Zip | 64735-3205
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Country | US
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Telephone | 660-885-8141
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Fax | 660-885-5815
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Provider Business Mailing Address
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Address Line | 901 E. 104TH ST. MAILSTOP 400N
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City | KANSAS CITY
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State | MO
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Zip | 64131
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Country | US
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Telephone | 816-502-7104
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 129500
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License Number State | MO
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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 | 129500
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License Number State | MO
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