Provider Demographics
NPI:1063440915
Name:SURBER, JANESE B (APRN)
Entity type:Individual
Prefix:
First Name:JANESE
Middle Name:B
Last Name:SURBER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JANESE
Other - Middle Name:R
Other - Last Name:BEATTIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:2790 CLAY EDWARDS DR STE 600
Mailing Address - Street 2:
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3274
Mailing Address - Country:US
Mailing Address - Phone:816-561-3003
Mailing Address - Fax:816-889-1584
Practice Address - Street 1:2790 CLAY EDWARDS DR
Practice Address - Street 2:STE 1230
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3276
Practice Address - Country:US
Practice Address - Phone:816-214-9300
Practice Address - Fax:816-214-9330
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO154572363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO154572OtherLICENSE NUMBER
MO154572OtherLICENSE NUMBER