MEDICARE: MRS. KATE MULLANE ROBERTSON CS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374K00000X	Religious Nonmedical Practitioner

General Provider Information

NPI Number	:	1912250671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATE MULLANE ROBERTSON CS

Provider Business Mailing Address
First Line	:	12 DWYER PL
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63124-1605
Country	:	US
Telephone Number	:	314-989-0112
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 DWYER PL
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63124-1605
Country	:	US
Telephone Number	:	314-324-2534
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2012
Last Update Date	:	10/18/2012

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