Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 53-80910-051 | KS |
NPI | 1295486983 |
---|---|
Provider Name | Mark Gagliardi |
First Address | Kansas City, MO 64131-3229 |
Second Address | Kansas City, KS 66160-8501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2022 |
Last Update Date | 10/02/2022 |