Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | 2005031368 | MO |
NPI | 1922066547 |
---|---|
Provider Name | Dr. Christina R. Cantrell |
First Address | Raymore, MO 64083-1352 |
Second Address | Raymore, MO 64083-9762 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 03/08/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11516513 | CAQH (01) | MO |
36497025 | BCBS (01) | MO |
697680 | ACN (01) | MO |
744328 | HEALTHLINK (01) | MO |
V07857 | (02) | MO |