Breneman, Michelle Lynn

Breneman, Michelle Lynn is an individual health care provider with primary practice located at 100 Brevco Plz Ste 101, Lake Saint Louis MO 63367-1382. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, which is considered as her primary health care specialty. Breneman, Michelle Lynn can be contacted via phone (636) 561-5437.

Contact Information

Primary practice address
100 Brevco Plz Ste 101 Lake Saint Louis MO 63367-1382
Phone: (636) 561-5437
Fax: (636) 561-5100
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 2003020311 Missouri

Profile Details

NPI number 1043484371
LBN Legal business name Breneman, Michelle Lynn
Credentials Pediatric Nurse Practitioner (PNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 17th, 2008
Last updated Apr 18th, 2025 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1043484371 NPPES
Missouri MEDICAID 420041212

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