Individual
MRS. MARY LOU BURGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4104 S 4TH ST, LEAVENWORTH, KS 66048-5082
(913) 682-2000
Mailing address
4104 S 4TH ST, LEAVENWORTH, KS 66048-5082
(913) 682-2000
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
23-23947-031
KS
Other
Enumeration date
04/17/2023
Last updated
04/17/2023
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