Provider Demographics
NPI:1245599075
Name:SAMBOL-GORDON, PEATRIC (RN,BSN,MBA,ACHA)
Entity Type:Individual
Prefix:MRS
First Name:PEATRIC
Middle Name:
Last Name:SAMBOL-GORDON
Suffix:
Gender:F
Credentials:RN,BSN,MBA,ACHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4646 SORTOR DR
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66104-1253
Mailing Address - Country:US
Mailing Address - Phone:913-233-6247
Mailing Address - Fax:
Practice Address - Street 1:4646 SORTOR DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66104-1253
Practice Address - Country:US
Practice Address - Phone:913-233-6247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1359686111163W00000X
MO122895163W00000X
KS3450163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator