Provider Demographics
NPI:1093123028
Name:HUBER, MAUREEN E (FNP)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:E
Last Name:HUBER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:E
Other - Last Name:BREDENKAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:13303 TESSON FERRY RD STE 45
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-4062
Mailing Address - Country:US
Mailing Address - Phone:314-748-5917
Mailing Address - Fax:314-748-5919
Practice Address - Street 1:13303 TESSON FERRY RD STE 45
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-4062
Practice Address - Country:US
Practice Address - Phone:314-748-5917
Practice Address - Fax:314-748-5919
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007004149163W00000X
MO2014025545363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse