Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | COA13849NP | OH |
Y | 363LA2100X | Nurse Practitioner - Acute Care | 2016001452 | MO |
N | 363LA2100X | Nurse Practitioner - Acute Care | COA.13849-NP | OH |
N | 363LA2100X | Nurse Practitioner - Acute Care | COA13849NP | OH |
NPI | 1033462049 |
---|---|
Provider Name | Mrs. Rachel Lynn Derenski |
First Address | Kansas City, MO 64131 |
Second Address | Kansas City, MO 64111-3220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2012 |
Last Update Date | 05/10/2018 |