Individual
MARK D. BANDERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2301 HOLMES ST, KANSAS CITY, MO 64108-2640
(816) 404-1127
(816) 404-1103
Mailing address
247 MARCELLUS DR, BEREA, KY 40403-2008
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
134568
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
134568
MO RN LICENSE
MO
01
—
1477923102
KS RN LICENSE
KS
Enumeration date
05/14/2007
Last updated
11/23/2020
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