Provider Demographics
NPI:1871607200
Name:BIRCHLER, JOAN K (RN, CPNP)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:K
Last Name:BIRCHLER
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 WENTZVILLE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385
Mailing Address - Country:US
Mailing Address - Phone:636-332-5400
Mailing Address - Fax:636-332-5404
Practice Address - Street 1:1413 WENTZVILLE PARKWAY
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385
Practice Address - Country:US
Practice Address - Phone:636-332-5400
Practice Address - Fax:636-332-5404
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO062658363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO423225101Medicaid
MO000080829Medicare ID - Type Unspecified
MO423225101Medicaid