1164739710 NPI number — MRS. MARY ELLEN KANTZ RN, BSN, CNOR, CRNFA

Table of content: MRS. MARY ELLEN KANTZ RN, BSN, CNOR, CRNFA (NPI 1164739710)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164739710 NPI number — MRS. MARY ELLEN KANTZ RN, BSN, CNOR, CRNFA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KANTZ
Provider First Name:
MARY
Provider Middle Name:
ELLEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN, BSN, CNOR, CRNFA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164739710
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2909 W ADAMS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST. CHARLES
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63301-4603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-724-0031
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
145 ST. PETERS CENTRE BLVD
Provider Second Line Business Practice Location Address:
RENAISSANCE PLASTIC SURGERY
Provider Business Practice Location Address City Name:
ST. PETERS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63376
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-896-0600
Provider Business Practice Location Address Fax Number:
636-723-2000
Provider Enumeration Date:
09/02/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WR0006X , with the licence number:  044729 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163W00000X , with the licence number: 044729 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com