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Individual

BREANA LYNEA DEWEESE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MS, PA-C

Contact information

Practice address
615 S NEW BALLAS RD UNIT 1200, SAINT LOUIS, MO 63141-8221
(314) 251-2880
Mailing address
2994 FOXWOOD DR, MARYLAND HEIGHTS, MO 63043-1346

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2024005758
MO

Other

Enumeration date
01/24/2024
Last updated
04/18/2024
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