Healthcare Provider Details

I. General information

NPI: 1881957504
Provider Name (Legal Business Name): JUDITH I BILDNER MCCNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 06/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 N KEENE ST
COLUMBIA MO
65201-6626
US

IV. Provider business mailing address

404 N KEENE ST
COLUMBIA MO
65201-6626
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-2272
  • Fax: 573-875-9862
Mailing address:
  • Phone: 573-882-2272
  • Fax: 573-875-9862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number088050
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: