Provider Demographics
NPI:1073718409
Name:BREWER, RACHAEL DAMASK (FNP)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:DAMASK
Last Name:BREWER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 BELLEVUE AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1846
Mailing Address - Country:US
Mailing Address - Phone:314-287-8080
Mailing Address - Fax:
Practice Address - Street 1:1035 BELLEVUE AVE STE 212
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1846
Practice Address - Country:US
Practice Address - Phone:314-287-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-16
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007024446163WE0003X
MO2014014875363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency