Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 2020025206 | MO |
NPI | 1043821556 |
---|---|
Provider Name | Sandra K Grebing |
First Address | Kansas City, MO 64180-1143 |
Second Address | Cape Girardeau, MO 63703-5049 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2020 |
Last Update Date | 02/03/2021 |