Healthcare Provider Details

I. General information

NPI: 1265419477
Provider Name (Legal Business Name): JANET S. MURDICK RN BC AP PMH/CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 COLLINS DR
FESTUS MO
63028-2346
US

IV. Provider business mailing address

789 COTTAGE ROAD
BONNE TERRE MO
63628
US

V. Phone/Fax

Practice location:
  • Phone: 636-931-4206
  • Fax:
Mailing address:
  • Phone: 573-358-0315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number104279
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: