Provider Demographics
NPI:1780193300
Name:HRUSKA, REBECCA (CSFA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:HRUSKA
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1503 BUCKHURST CT
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-8395
Mailing Address - Country:US
Mailing Address - Phone:618-616-1658
Mailing Address - Fax:
Practice Address - Street 1:615 S BALLAS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-5314
Practice Address - Country:US
Practice Address - Phone:618-616-1658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2021-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN165787363AS0400X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical