Individual
LAURA MABERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4401 WORNALL RD, KANSAS CITY, MO 64111-3220
(816) 932-7940
Mailing address
PO BOX 504407, SAINT LOUIS, MO 63150-4407
(816) 502-7000
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2008023013
MO
363LC0200X
Critical Care Medicine Nurse Practitioner
Primary
2015034749
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2008023013
RN LICENSE
MO
01
—
2015034749
LICENSE
MO
Enumeration date
08/05/2015
Last updated
09/30/2015
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