Provider Demographics
NPI:1386008035
Name:NEWBERRY, GINA (CRNA)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:NEWBERRY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:13515 BARRETT PARKWAY DR
Mailing Address - Street 2:SUITE 170
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-5870
Mailing Address - Country:US
Mailing Address - Phone:469-757-1042
Mailing Address - Fax:855-917-2066
Practice Address - Street 1:12303 DE PAUL DR
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2512
Practice Address - Country:US
Practice Address - Phone:469-757-1042
Practice Address - Fax:855-917-2066
Is Sole Proprietor?:No
Enumeration Date:2016-04-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009030293367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered