Individual
DAGAN RANDAL EICHHOLZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSN, PMHNP-BC
Contact information
Practice address
300 SE 2ND ST, LEES SUMMIT, MO 64063-2759
(816) 404-6191
Mailing address
300 SE 2ND ST, LEES SUMMIT, MO 64063-2759
(816) 404-6170
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2008003471
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
420051522
—
MO
Enumeration date
02/13/2018
Last updated
12/23/2020
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