Individual
MARY J BJORNSTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
965 MATTOX DR, SULLIVAN, MO 63080-2365
(573) 860-6000
(573) 860-6016
Mailing address
965 MATTOX DR, SULLIVAN, MO 63080-2365
(573) 860-6000
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
072682
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
425813508
—
MO
Enumeration date
08/30/2006
Last updated
05/13/2021
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