Healthcare Provider Details

I. General information

NPI: 1568041648
Provider Name (Legal Business Name): JENNA ELISE BRETTSCHNEIDER DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD STE 7005
SAINT LOUIS MO
63141-8232
US

IV. Provider business mailing address

621 S NEW BALLAS RD STE 7005
SAINT LOUIS MO
63141-8232
US

V. Phone/Fax

Practice location:
  • Phone: 314-991-3668
  • Fax: 313-343-3401
Mailing address:
  • Phone: 314-991-3668
  • Fax: 314-991-3665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2024017623
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: