Provider Demographics
NPI:1114928629
Name:BREFELD, LINDSAY RAE (PNP-C, APN)
Entity Type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:RAE
Last Name:BREFELD
Suffix:
Gender:F
Credentials:PNP-C, APN
Other - Prefix:MS
Other - First Name:LINDSAY
Other - Middle Name:RAE
Other - Last Name:HEINZMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PNP-C, APN
Mailing Address - Street 1:1465 S GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-1003
Mailing Address - Country:US
Mailing Address - Phone:314-577-5394
Mailing Address - Fax:
Practice Address - Street 1:1465 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1003
Practice Address - Country:US
Practice Address - Phone:314-577-5394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO154651363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO427196902Medicaid
MO427196902Medicaid