Individual
MRS. MARY ELLEN KANTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, BSN, CNOR, CRNFA
Contact information
Practice address
145 ST. PETERS CENTRE BLVD, RENAISSANCE PLASTIC SURGERY, ST. PETERS, MO 63376
(636) 896-0600
(636) 723-2000
Mailing address
2909 W ADAMS, ST. CHARLES, MO 63301-4603
(636) 724-0031
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
044729
MO
163WR0006X
Registered Nurse First Assistant
Primary
044729
MO
Other
Enumeration date
09/02/2010
Last updated
12/06/2011
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