Healthcare Provider Details

I. General information

NPI: 1568814234
Provider Name (Legal Business Name): MRS. JESSICA FREIBERGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 07/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 CARDWELL ST
SAINT CLAIR MO
63077-1094
US

IV. Provider business mailing address

1001 CARDWELL ST
SAINT CLAIR MO
63077-1094
US

V. Phone/Fax

Practice location:
  • Phone: 636-629-3300
  • Fax: 636-629-7377
Mailing address:
  • Phone: 636-629-3300
  • Fax: 636-629-7377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2010018171
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2016025002
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: