Buwalda, Rebecca Deatherage

Buwalda, Rebecca Deatherage is an individual health care provider with primary practice located at 12255 De Paul Dr Ste 600 , Bridgeton MO 63044-2515. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Buwalda, Rebecca Deatherage can be contacted via phone (314) 209-5100.

Contact Information

Primary practice address
12255 De Paul Dr Ste 600 Bridgeton MO 63044-2515
Phone: (314) 209-5100
Fax: (314) 291-9508
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X FNP 124462 Missouri

Profile Details

NPI number 1366477226
LBN Legal business name Buwalda, Rebecca Deatherage
Credentials APRNBC
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 11th, 2006
Last updated Oct 20th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1366477226 NPPES
Missouri Other P21556 RAILROAD MEDICARE

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