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NPI Code Detail

MEDICARE: BIANCA MARIA MUDD R.N.

MEDICARE: BIANCA MARIA MUDD R.N.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse2012010818MO
2374J00000XDoula
3405300000XPrevention Professional2012010818MO

General Provider Information

NPI Number : 1609113539
Entity Type Code : Individual
Provider Name (Legal Business Name) : BIANCA MARIA MUDD R.N.
Provider Business Mailing Address
First Line : 6121 N HANLEY RD
Second Line :
City : BERKELEY
State : MO
Zip : 63134-2003
Country : US
Telephone Number : 314-269-4287
Fax Number :
Provider Business Practice Location Address
First Line : 6121 N HANLEY RD
Second Line :
City : BERKELEY
State : MO
Zip : 63134-2003
Country : US
Telephone Number : 314-269-4287
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2013
Last Update Date : 02/12/2019

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Directions to “ BIANCA MARIA MUDD R.N.” Practice Location

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