Individual
MARY JANE KING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3657 BAPTIST PARK RD, MAPAVILLE, MO 63065
(636) 931-0080
Mailing address
565 WALL ST, HERCULANEUM, MO 63048-1126
(573) 701-6748
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
2001004925
MO
Other
Enumeration date
08/21/2024
Last updated
08/21/2024
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