| Doctor Name: | ANASTASIA A AVERBUKH |
| NPI Number: | 1073903134 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | 2014031123 |
| Business Practice Address: | 1011 Bowles Avenue Suite 121 Fenton, MO - 630262387 |
| Business Phone Number: | 3142002713 |
| Business Fax Number: | 3142002714 |
| Mailing Address: | 1011 Bowles Avenue, Suite 121 FENTON |
| State: | MO |
| Postal Code: | 630262387 |
| Phone Number: | 3142002713 |
| Fax Number: | 3142002714 |
| NPI Enumeration Date: | 01/28/2015 |
| NPI Last Update Date: | 05/13/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 2014031123 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |