Individual provider · Type 1 NPI
Mary Jane Broge, PNP
Pediatric Nurse Practitioner · St. Louis, MO
NPI number
1295066769
Active
Practice location
1 Childrens Pl, Div Ped Cardiology
St. Louis, MO 63110-1002
Fax (314) 884-6008
Mailing address
PO Box 7412011
Chicago, IL 60674-2011
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Pediatric Nurse Practitioner Primary | 363LP0200X | 2004033032 (MO) |
Pediatric Nurse Practitioner: Definition to come...
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About NPI 1295066769
Mary Jane Broge, PNP's National Provider Identifier is 1295066769, issued on Jan 23, 2010. The primary taxonomy on file is Pediatric Nurse Practitioner (363LP0200X), and the practice location is in St. Louis, MO. The record was last updated on Feb 9, 2026.