Provider Demographics
NPI:1306024781
Name:WIERSEMA BRYANT, LAUREL A (ANP)
Entity Type:Individual
Prefix:MS
First Name:LAUREL
Middle Name:A
Last Name:WIERSEMA BRYANT
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Gender:F
Credentials:ANP
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:MSC 8109-43-1160
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-747-2829
Mailing Address - Fax:314-362-5743
Practice Address - Street 1:1 BARNES JEWISH HOSPITAL PLZ
Practice Address - Street 2:DIV SURG GENERAL
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1003
Practice Address - Country:US
Practice Address - Phone:314-747-2829
Practice Address - Fax:314-362-5743
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2021-11-15
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Provider Licenses
StateLicense IDTaxonomies
MO080003363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO427861406Medicaid