Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 2017000664 | MO |
N | 363LP2300X | Nurse Practitioner - Primary Care | 2017000664 | MO |
NPI | 1033655394 |
---|---|
Provider Name | Doris Marie Mosby-Peterson |
First Address | Raytown, MO 64133-8447 |
Second Address | Kansas City, MO 64130-3048 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2017 |
Last Update Date | 15/08/2017 |