Michelle Lynn Breneman, PNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

2003020311 Issued in MO

Practice address

100 Brevco PLZ
Ste 101
Lake Saint Louis, MO 63367-1382

Phone

(636) 561-5437

Fax

(636) 561-5100

NPI assigned

Apr 17, 2008

Last updated

Apr 18, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wuca-Westside Pediatrics LLC

  • Pediatrics Physician
  • Lake St Louis, MO
  • NPI 1700325123
  Medicare reassignment NPD
• Naresh Solanki Inc

  dba Westside Pediatrics

  • Pediatric Adolescent Medicine Physician
  • Lake St Louis, MO
  • NPI 1316089022
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744934400000",
    "number": "1043484371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412119",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742119",
            "telephone_number": "636-561-5437",
            "fax_number": "636-561-5100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 BREVCO PLZ",
            "address_2": "STE 101",
            "city": "LAKE SAINT LOUIS",
            "state": "MO",
            "postal_code": "633671382",
            "telephone_number": "636-561-5437",
            "fax_number": "636-561-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRENEMAN",
        "first_name": "MICHELLE",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "PNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-17",
        "last_updated": "2025-04-18",
        "certification_date": "2024-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MO",
            "license": "2003020311",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "420041212",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "100 Brevco Plz",
            "address_2": "STE 101",
            "city": "Lake Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "633671382",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Donald Beussink
• Kieara Bond, RN
• Borello Orthodontics
• Blake Borello, D.D.S., M.S.
• Brain to Behavior LLC
• Bright Horizons Pediatric Therapy LLC
• By Word and Deed LLC
• Samantha Callahan, LPC
• Marie Erin Carmi, MA LPC
• Cara Ann Carrothers Peroutka, LPC

• Pediatric Nurse Practitioner in Lake Saint Louis, MO
• Providers in Lake Saint Louis, MO by specialty
• Pediatric Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.