| Doctor Name: | MARY BJORNSTAD |
| NPI Number: | 1104935261 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 072682 |
| Business Practice Address: | 965 Mattox Dr Sullivan, MO - 630802365 |
| Business Phone Number: | 5738606000 |
| Business Fax Number: | 5738606016 |
| Mailing Address: | 670 Mason Ridge Center Dr, Suite 300 SAINT LOUIS |
| State: | MO |
| Postal Code: | 631418573 |
| Phone Number: | 5738606000 |
| Fax Number: | 5738606016 |
| NPI Enumeration Date: | 08/30/2006 |
| NPI Last Update Date: | 01/06/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 072682 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |