Healthcare Provider Details

I. General information

NPI: 1295409902
Provider Name (Legal Business Name): LAUREN M BREWER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2021
Last Update Date: 04/15/2025
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 FOREST PARK AVE DIV IM HEMATOLOGY, 6TH FL
SAINT LOUIS MO
63108-2114
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-7216
  • Fax: 314-696-1391
Mailing address:
  • Phone: 314-362-7216
  • Fax: 314-696-1391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2020011019
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2020011019
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: