Provider Demographics
NPI:1265419477
Name:MURDICK, JANET S (RN BC AP PMH/CNS)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:S
Last Name:MURDICK
Suffix:
Gender:F
Credentials:RN BC AP PMH/CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:789 COTTAGE ROAD
Mailing Address - Street 2:
Mailing Address - City:BONNE TERRE
Mailing Address - State:MO
Mailing Address - Zip Code:63628
Mailing Address - Country:US
Mailing Address - Phone:573-358-0315
Mailing Address - Fax:
Practice Address - Street 1:807 COLLINS DR
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-2346
Practice Address - Country:US
Practice Address - Phone:636-931-4206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO104279364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO425915600Medicaid