Healthcare Provider Details

I. General information

NPI: 1528819695
Provider Name (Legal Business Name): JEAN KIBURZ PCNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 S GRAND BLVD
SAINT LOUIS MO
63104-1003
US

IV. Provider business mailing address

1465 S GRAND BLVD
SAINT LOUIS MO
63104-1003
US

V. Phone/Fax

Practice location:
  • Phone: 314-268-2700
  • Fax: 314-268-6438
Mailing address:
  • Phone: 314-268-2700
  • Fax: 314-268-6438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number093368
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: