Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | R8D92 | MO |
NPI | 1003819137 |
---|---|
Provider Name | Susan Marie Mou |
First Address | Kansas City, MO 64108-2602 |
Second Address | Kansas City, MO 64108-2727 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 08/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C51314 | (02) |