Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 2017004799 | MO |
NPI | 1003355322 |
---|---|
Provider Name | Randyn Wertz |
First Address | Kansas City, MO 64114-1344 |
Second Address | Kansas City, MO 64114-1344 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2017 |
Last Update Date | 20/02/2017 |