Basic Information
| Provider Information | |||||||||
| NPI: | 1558683540 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OMUNDSON | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 E 104TH ST | ||||||||
| Address2: | MAILSTOP 400N | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641314517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165999499 | ||||||||
| FaxNumber: | 8169329670 | ||||||||
| Practice Location | |||||||||
| Address1: | 9107 NW 45 HWY | ||||||||
| Address2: | |||||||||
| City: | PARKVILLE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641523958 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162515775 | ||||||||
| FaxNumber: | 8162515776 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2010 | ||||||||
| LastUpdateDate: | 03/30/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WW0101X | 1487941072 | KS | N | Nursing Service Providers | Registered Nurse | Women's Health Care, Ambulatory | 363LF0000X | 53-76735 | KS | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 2015005069 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | VADOO | 01 | UPIN | OTHER |