Healthcare Provider Details

I. General information

NPI: 1114928629
Provider Name (Legal Business Name): LINDSAY RAE BREFELD PNP-C, APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDSAY RAE HEINZMANN PNP-C, APN

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 11/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 S GRAND BLVD
SAINT LOUIS MO
63104-1003
US

IV. Provider business mailing address

1465 S GRAND BLVD
SAINT LOUIS MO
63104-1003
US

V. Phone/Fax

Practice location:
  • Phone: 314-577-5394
  • Fax:
Mailing address:
  • Phone: 314-577-5394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number154651
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: