Individual
MARY V CHANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
601 S 169 HWY, SMITHVILLE, MO 64089-9317
(816) 461-8288
(816) 461-6586
Mailing address
969 NORTHWYCK DR, LIBERTY, MO 64068-3354
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
104029
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200305140A
—
MO
05
—
429019003
—
KS
Enumeration date
03/29/2006
Last updated
03/28/2012
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