MEDICARE: MRS. KATHRYN MARY BLUNDELL RN, BSN, CNOR, CRNFA

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	163WR0006X	Registered Nurse First Assistant	104838	MO
2	163WR0006X	Registered Nurse First Assistant	13-55986-051	KS

General Provider Information

NPI Number	:	1174618896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHRYN MARY BLUNDELL RN, BSN, CNOR, CRNFA

Provider Business Mailing Address
First Line	:	801 E 30TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64109-1413
Country	:	US
Telephone Number	:	816-531-2861
Fax Number	:	816-531-2863

Provider Business Practice Location Address
First Line	:	801 E 30TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64109-1413
Country	:	US
Telephone Number	:	816-531-2861
Fax Number	:	816-531-2863

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/08/2007

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