MEDICARE: MRS. DEBORAH C WASHAM RN

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	174400000X	Specialist	067295	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21640012	OTHER		BLUECROSS BLUE SHIELD

General Provider Information

NPI Number	:	1649331489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBORAH C WASHAM RN

Provider Business Mailing Address
First Line	:	12435 WORNALL RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64145-1119
Country	:	US
Telephone Number	:	816-943-6465
Fax Number	:	816-943-1235

Provider Business Practice Location Address
First Line	:	12435 WORNALL RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64145-1119
Country	:	US
Telephone Number	:	816-943-6465
Fax Number	:	816-943-1235

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

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	07/08/2007

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