Provider Demographics
NPI:1598853699
Name:HASSLER, REBEKAH (CNM, FNP)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:HASSLER
Suffix:
Gender:F
Credentials:CNM, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 HELEN ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63106-3001
Mailing Address - Country:US
Mailing Address - Phone:314-482-9565
Mailing Address - Fax:314-814-8542
Practice Address - Street 1:3930 S BROADWAY
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-4626
Practice Address - Country:US
Practice Address - Phone:314-898-1999
Practice Address - Fax:314-814-8542
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO121145363LF0000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO428889935Medicaid
MO080292Medicare PIN
MO428889935Medicaid