Individual
JACQUELINE BIONDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RNC, NNP
Contact information
Practice address
2401 GILLHAM ROAD, ATTN: PROVIDER ENROLLMENT DEPARTMENT, KANSAS CITY, MO 64108-4619
(816) 701-5200
(816) 302-9939
Mailing address
2401 GILLHAM ROAD, ATTN: PROVIDER ENROLLMENT DEPARTMENT, KANSAS CITY, MO 64108-4619
(816) 701-5200
(816) 302-9939
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
NP 107501
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200001330B
—
KS
05
—
429191000
—
MO
01
—
466390
FIRST GUARD
MO
Enumeration date
06/04/2006
Last updated
04/30/2021
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