Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 5346199032 | KS |
NPI | 1023319415 |
---|---|
Provider Name | Saxton Gragg |
First Address | Shawnee, KS 66218-9795 |
Second Address | Overland Park, KS 66215-2306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2010 |
Last Update Date | 16/11/2010 |