Provider Demographics
NPI:1083375943
Name:HAGER, REBEKAH ANN (NP)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:ANN
Last Name:HAGER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 FOREST PARK AVE STE 420
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-1453
Mailing Address - Country:US
Mailing Address - Phone:314-362-9100
Mailing Address - Fax:314-362-9107
Practice Address - Street 1:4901 FOREST PARK AVE STE 420
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1453
Practice Address - Country:US
Practice Address - Phone:314-362-9100
Practice Address - Fax:314-362-9107
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016006246163W00000X
MO2022003923363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2016003246OtherRN
MO2022003923OtherNPI