Healthcare Provider Details

I. General information

NPI: 1326117581
Provider Name (Legal Business Name): MARY KATHERINE BURCH RNC, WHNP, MC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11652 STUDT AVE
SAINT LOUIS MO
63141-7025
US

IV. Provider business mailing address

11652 STUDT AVE
SAINT LOUIS MO
63141-7025
US

V. Phone/Fax

Practice location:
  • Phone: 314-991-5445
  • Fax: 314-991-5447
Mailing address:
  • Phone: 314-991-5445
  • Fax: 314-991-5447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number1999138040
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: