Provider Demographics
NPI:1437896974
Name:BRUSLIK, NATALIYA
Entity Type:Individual
Prefix:
First Name:NATALIYA
Middle Name:
Last Name:BRUSLIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NATALIYA
Other - Middle Name:
Other - Last Name:SYTYASHENKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGNP
Mailing Address - Street 1:16 TUPELO CT
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-5999
Mailing Address - Country:US
Mailing Address - Phone:314-330-5516
Mailing Address - Fax:
Practice Address - Street 1:3015 N BALLAS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2329
Practice Address - Country:US
Practice Address - Phone:314-996-5060
Practice Address - Fax:314-996-4596
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOAG05210062363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOAG05210062Medicaid