Healthcare Provider Details

I. General information

NPI: 1598853699
Provider Name (Legal Business Name): REBEKAH HASSLER CNM, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3930 S BROADWAY
SAINT LOUIS MO
63118-4626
US

IV. Provider business mailing address

1612 HELEN ST
SAINT LOUIS MO
63106-3001
US

V. Phone/Fax

Practice location:
  • Phone: 314-898-1999
  • Fax: 314-814-8542
Mailing address:
  • Phone: 314-482-9565
  • Fax: 314-814-8542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number121145
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number121145
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: