Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 2020035062 | MO |
N | 363LA2200X | Nurse Practitioner - Adult Health | 2020035062 | MO |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 2020035062 | MO |
NPI | 1396344289 |
---|---|
Provider Name | Jordana Culanculan |
First Address | Kansas City, MO 64154-1283 |
Second Address | Saint Louis, MO 63110-1003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2020 |
Last Update Date | 21/10/2020 |