Provider Demographics
NPI:1841518693
Name:GREENHAGEN, RACHEL R (CRNA)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:R
Last Name:GREENHAGEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:R
Other - Last Name:JOURNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 410245
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64141-0245
Mailing Address - Country:US
Mailing Address - Phone:913-642-4900
Mailing Address - Fax:913-381-0979
Practice Address - Street 1:5325 FARAON ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3488
Practice Address - Country:US
Practice Address - Phone:816-271-1365
Practice Address - Fax:816-271-6753
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007011320367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO452000011Medicare PIN