Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 2017024382 | MO |
N | 363LN0000X | Nurse Practitioner - Neonatal | 53-77792-041 | KS |
NPI | 1164946976 |
---|---|
Provider Name | Sara Melissa Corpuz |
First Address | Kansas City, MO 64108-4619 |
Second Address | Kansas City, MO 64108-4619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2017 |
Last Update Date | 18/08/2017 |