Individual
ROSE IYEWARUN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
6311 EVANSTON AVE, RAYTOWN, MO 64133-4929
(816) 272-2533
Mailing address
6311 EVANSTON AVE, RAYTOWN, MO 64133-4929
(816) 328-9304
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
1867
MO
374U00000X
Home Health Aide
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1700253150
—
MO
05
—
1952727273
—
MO
Enumeration date
02/25/2019
Last updated
07/18/2023
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