Provider Demographics
NPI:1508904459
Name:BREUER, NANCY L (PSYD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:BREUER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 S NATIONAL AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2222
Mailing Address - Country:US
Mailing Address - Phone:417-820-9590
Mailing Address - Fax:417-820-9592
Practice Address - Street 1:2030 S NATIONAL AVE STE 105
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2222
Practice Address - Country:US
Practice Address - Phone:417-820-9590
Practice Address - Fax:417-820-9592
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01921103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO493864201Medicaid
AR168119719Medicaid
MO000071019Medicare PIN