Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 2013031759 | MO |
NPI | 1194164152 |
---|---|
Provider Name | Adrianne Jean Black |
First Address | Shawnee, KS 66216-2030 |
Second Address | Kansas City, MO 64108-4619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2013 |
Last Update Date | 11/10/2017 |