Healthcare Provider Details

I. General information

NPI: 1730003195
Provider Name (Legal Business Name): SABREA BLOEBAUM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S EUCLID AVE
SAINT LOUIS MO
63110-1010
US

IV. Provider business mailing address

7429 RUPERT AVE
SAINT LOUIS MO
63117-2456
US

V. Phone/Fax

Practice location:
  • Phone: 314-286-2530
  • Fax:
Mailing address:
  • Phone: 314-283-5076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2022036238
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: