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General NPI Number Information
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NPI Number | 1164739710
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Entity Type | Individual
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Provider Name | MARY ELLEN KANTZ RN, BSN, CNOR, CRNFA
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Gender | Female
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Dates
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Enumeration Date | 09/02/2010
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Last Update Date | 12/06/2011
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Provider Practice Location Address
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Address Line | 145 ST. PETERS CENTRE BLVD RENAISSANCE PLASTIC SURGERY
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City | ST. PETERS
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State | MO
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Zip | 63376
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Country | US
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Telephone | 636-896-0600
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Fax | 636-723-2000
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Provider Business Mailing Address
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Address Line | 2909 W ADAMS
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City | ST. CHARLES
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State | MO
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Zip | 63301-4603
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Country | US
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Telephone | 636-724-0031
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WR0006X
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Taxonomy Name | Registered Nurse First Assistant
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License Number | 044729
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 044729
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License Number State | MO
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