MEDICARE: MONICA REVAE BEARS LPN

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	164W00000X	Licensed Practical Nurse	2004029600	MO

General Provider Information

NPI Number	:	1508950387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA REVAE BEARS LPN

Provider Business Mailing Address
First Line	:	RR 2 BOX 115
Second Line	:
City	:	SWEET SPRINGS
State	:	MO
Zip	:	65351-9348
Country	:	US
Telephone Number	:	660-335-4138
Fax Number	:

Provider Business Practice Location Address
First Line	:	5308 LONGVIEW RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64137-2731
Country	:	US
Telephone Number	:	816-763-9165
Fax Number	:	816-763-9208

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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Directions to “ MONICA REVAE BEARS LPN” Practice Location

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