Basic Information
| Provider Information | |||||||||
| NPI: | 1437526126 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BORDNER | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | MCGINLEY | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2109 MERAMEC OAK CT | ||||||||
| Address2: | |||||||||
| City: | FENTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630262774 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6368256254 | ||||||||
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| Practice Location | |||||||||
| Address1: | 121 SAINT LUKES CENTER DR STE 303 | ||||||||
| Address2: | |||||||||
| City: | CHESTERFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630173519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3144343278 | ||||||||
| FaxNumber: | 3145905949 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2015 | ||||||||
| LastUpdateDate: | 08/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 2009003028 | MO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363L00000X | 2015037207 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.