Basic Information
| Provider Information | |||||||||
| NPI: | 1457855116 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUGAN | ||||||||
| FirstName: | MARRIANN | ||||||||
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| Credential: | CRNA, DNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6403 BLUEJACKET ST | ||||||||
| Address2: | |||||||||
| City: | SHAWNEE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662033545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136317585 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4000 CAMBRIDGE ST | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9135881227 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2018 | ||||||||
| LastUpdateDate: | 06/18/2018 | ||||||||
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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 | 390200000X | 390200000X | KS | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 367500000X | 557599 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.