Individual
AMY JO MASIONGALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2100 SE BLUE PKWY, LEES SUMMIT, MO 64063
(913) 428-2900
(913) 428-2951
Mailing address
8717 W 110TH ST STE 600, OVERLAND PARK, KS 66210-2126
(913) 428-2900
(913) 428-2951
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2018044045
MO
367500000X
Certified Registered Nurse Anesthetist
43-557644
KS
367500000X
Certified Registered Nurse Anesthetist
RN101263
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000731607C
—
GA
05
—
000731607D
—
GA
01
—
339446
WELLCARE CMO
GA
01
—
430079467
RRMEDICARE
GA
01
—
550789920
TRICARE
GA
05
—
GAN227
—
SC
Enumeration date
11/13/2006
Last updated
01/18/2019
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