Provider Demographics
NPI:1003247693
Name:BREWER-PEET, JODIE (PA-C)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:
Last Name:BREWER-PEET
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JODIE
Other - Middle Name:
Other - Last Name:BREWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1400 E KINCAID ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:360-445-8592
Practice Address - Street 1:127 NE CAMANO DR STE A
Practice Address - Street 2:
Practice Address - City:CAMANO ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98282-8732
Practice Address - Country:US
Practice Address - Phone:360-387-5398
Practice Address - Fax:360-629-1644
Is Sole Proprietor?:No
Enumeration Date:2013-12-06
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60436751363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2034971Medicaid
WAG8929938Medicare UPIN