Healthcare Provider Details

I. General information

NPI: 1003933631
Provider Name (Legal Business Name): NANCY M. BIRTLEY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 11/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6209 MID RIVERS MALL DR #317
SAINT PETERS MO
63304-1102
US

IV. Provider business mailing address

6209 MID RIVERS MALL DR #317
SAINT PETERS MO
63304-1102
US

V. Phone/Fax

Practice location:
  • Phone: 636-244-4500
  • Fax: 636-244-4505
Mailing address:
  • Phone: 636-244-4500
  • Fax: 636-244-4505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number107603
License Number StateMO

VIII. Authorized Official

Name: PATRICE M FLANAGAN
Title or Position: PRACTICE MANAGER
Credential: RN, MBA
Phone: 636-244-4500