Individual
BRENLEY DETERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1060 MEYER RD, WENTZVILLE, MO 63385-3800
(314) 230-1500
Mailing address
1060 MEYER RD, WENTZVILLE, MO 63385-3800
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
2023010764
MO
363A00000X
Physician Assistant
Primary
2023010764
MO
Other
Enumeration date
02/24/2023
Last updated
05/21/2024
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