Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0210X | Pediatric Nephrologist | 04-36152 | KS |
Y | 2080P0210X | Pediatric Nephrologist | 2007029194 | MO |
NPI | 1174797385 |
---|---|
Provider Name | Dr. Judith Sebestyen Vansickle |
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 | 17/04/2008 |
Last Update Date | 23/02/2015 |