Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 2019039975 | MO |
NPI | 1003440215 |
---|---|
Provider Name | Mrs. Cassondra Dawn Simmoneau |
First Address | Kansas City, MO 64180-2843 |
Second Address | Springfield, MO 65807-5210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2020 |
Last Update Date | 16/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
420081106 | (05) | MO |