Provider Demographics
NPI:1891771036
Name:UNGASHICK, STEPHANIE L (CRNA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:UNGASHICK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16663 MIDLAND DR # 200
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66217-3042
Mailing Address - Country:US
Mailing Address - Phone:913-227-4618
Mailing Address - Fax:
Practice Address - Street 1:16663 MIDLAND DR # 200
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66217-3042
Practice Address - Country:US
Practice Address - Phone:913-227-4618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO132331367500000X
KS54704367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO914810700Medicaid
KS100356590AMedicaid