| Doctor Name: | STACEY E BROUK |
| NPI Number: | 1558511048 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RD, LD |
| License Number: | 2008030030 |
| Business Practice Address: | 10007 Kennerly Rd Suite A Saint Louis, MO - 631282179 |
| Business Phone Number: | 3147767112 |
| Business Fax Number: | 3147767114 |
| Mailing Address: | Po Box 29255, SAINT LOUIS |
| State: | MO |
| Postal Code: | 631260255 |
| Phone Number: | 3147767112 |
| Fax Number: | 3147767114 |
| NPI Enumeration Date: | 09/22/2008 |
| NPI Last Update Date: | 10/04/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | 2008030030 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |