Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | 13-37886-071 | KS |
Y | 363LN0000X | Nurse Practitioner - Neonatal | 2004002628 | MO |
NPI | 1144288473 |
---|---|
Provider Name | Bernice Averill |
First Address | Kansas City, MO 64108-4619 |
Second Address | Kansas City, MO 64108-4619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
13-37886-071 | KS LICENSE (01) | KS |
2004002628 | MO LICENSE (01) | MO |