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General NPI Number Information
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NPI Number | 1780193300
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Entity Type | Individual
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Provider Name | REBECCA HRUSKA CSFA
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Gender | Female
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Dates
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Enumeration Date | 09/26/2017
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Last Update Date | 10/10/2021
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Provider Practice Location Address
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Address Line | 615 S BALLAS RD
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City | SAINT LOUIS
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State | MO
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Zip | 63122-5314
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Country | US
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Telephone | 618-616-1658
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Fax |
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Provider Business Mailing Address
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Address Line | 1503 BUCKHURST CT
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City | BALLWIN
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State | MO
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Zip | 63021-8395
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Country | US
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Telephone | 618-616-1658
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 165787
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License Number State | TN
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