=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972728582
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHAVONNE L DANNER M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2007
-----------------------------------------------------
Last Update Date | 02/19/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2525 GLENN HENDREN DR
-----------------------------------------------------
City | LIBERTY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64068-9625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-407-2028
-----------------------------------------------------
Fax | 816-407-4880
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 455
-----------------------------------------------------
City | LIBERTY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64069-0455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-407-2028
-----------------------------------------------------
Fax | 816-407-4606
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | R3N16
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------