Individual
JENNIFER L DISTASIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2790 CLAY EDWARDS DR STE 1200, NORTH KANSAS CITY, MO 64116-3253
(816) 468-7800
(816) 468-8531
Mailing address
2790 CLAY EDWARDS DR STE 1200, NORTH KANSAS CITY, MO 64116-3253
(816) 468-7800
(816) 468-8531
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
2010019752
MO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396065447
—
MO
Enumeration date
06/10/2010
Last updated
10/19/2017
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