MEDICARE: ANN MARIE HOMBURGER RN, BC, M-SCNS

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	364S00000X	Clinical Nurse Specialist	078881	MO

General Provider Information

NPI Number	:	1578543542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN MARIE HOMBURGER RN, BC, M-SCNS

Provider Business Mailing Address
First Line	:	PO BOX 931634
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64193-0001
Country	:	US
Telephone Number	:	816-461-8288
Fax Number	:	816-461-6586

Provider Business Practice Location Address
First Line	:	4400 WORNALL RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-3238
Country	:	US
Telephone Number	:	816-461-8288
Fax Number	:	816-461-6586

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

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	07/08/2007

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