MEDICARE: JANESE B SURBER APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	154572	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	154572	OTHER	MO	LICENSE NUMBER

General Provider Information

NPI Number	:	1063440915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANESE B SURBER APRN

Provider Business Mailing Address
First Line	:	2790 CLAY EDWARDS DR STE 600
Second Line	:
City	:	NORTH KANSAS CITY
State	:	MO
Zip	:	64116-3274
Country	:	US
Telephone Number	:	816-561-3003
Fax Number	:	816-889-1584

Provider Business Practice Location Address
First Line	:	2790 CLAY EDWARDS DR
Second Line	:	STE 1230
City	:	NORTH KANSAS CITY
State	:	MO
Zip	:	64116-3276
Country	:	US
Telephone Number	:	816-214-9300
Fax Number	:	816-214-9330

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	04/03/2018

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Directions to “ JANESE B SURBER APRN” Practice Location

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