Individual
NICOLE M BURDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
10004 KENNERLY RD STE 115A, SAINT LOUIS, MO 63128-5106
(314) 525-1538
Mailing address
10004 KENNERLY RD STE 115A, SAINT LOUIS, MO 63128-5106
(314) 525-1538
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
2020027480
MO
363LF0000X
Family Nurse Practitioner
Primary
2020027480
MO
Other
Enumeration date
09/22/2020
Last updated
12/17/2024
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