1134529589 NPI number — CAITLIN JANELLE SUNDERMAN P.A.-C

Table of content: CAITLIN JANELLE SUNDERMAN P.A.-C (NPI 1134529589)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134529589 NPI number — CAITLIN JANELLE SUNDERMAN P.A.-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUNDERMAN
Provider First Name:
CAITLIN
Provider Middle Name:
JANELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PHILLIPS
Provider Other First Name:
CAITLIN
Provider Other Middle Name:
JANELLE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134529589
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/01/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1004 CARONDELET DRIVE
Provider Second Line Business Mailing Address:
SUITE 330
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-941-6400
Provider Business Mailing Address Fax Number:
816-941-6404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1004 CARONDELET DRIVE
Provider Second Line Business Practice Location Address:
SUITE 330
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-941-6400
Provider Business Practice Location Address Fax Number:
816-941-6404
Provider Enumeration Date:
09/03/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  2014025935 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com