Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | 2014004556 | MO |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 2014004556 | MO |
NPI | 1093139628 |
---|---|
Provider Name | Brenna Primrose |
First Address | Kansas City, MO 64111-3220 |
Second Address | Kansas City, MO 64111-3220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2014 |
Last Update Date | 21/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2014004556 | LICENSE (01) | MO |