Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | NP 104422 | MO |
NPI | 1003859034 |
---|---|
Provider Name | Mary Hagerty |
First Address | Kansas City, MO 64132-1136 |
Second Address | Kansas City, MO 64132-1136 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
466300 | FIRST GUARD (01) | MO |