Provider Demographics
NPI:1982816450
Name:GUM, TAMARA-JANE HARDING (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA-JANE
Middle Name:HARDING
Last Name:GUM
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 1:1009 NE 94TH COURT
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155
Mailing Address - Country:US
Mailing Address - Phone:816-436-4279
Mailing Address - Fax:
Practice Address - Street 1:250 NE MULBERRY ST
Practice Address - Street 2:C/O SJS MEDICAL MANAGEMENT, SUITE 202
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-4533
Practice Address - Country:US
Practice Address - Phone:816-389-4130
Practice Address - Fax:816-389-4140
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO129913367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO39408094OtherBCBS KC
MOP02156077OtherRAILROAD
MO914603907Medicaid