Provider Demographics
NPI:1003901216
Name:BREWER, PATRICIA LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LYNN
Last Name:BREWER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29148 HWY 200 E
Mailing Address - Street 2:
Mailing Address - City:BONNER
Mailing Address - State:MT
Mailing Address - Zip Code:59823-9541
Mailing Address - Country:US
Mailing Address - Phone:406-901-0106
Mailing Address - Fax:
Practice Address - Street 1:2415 S CATLIN ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-7822
Practice Address - Country:US
Practice Address - Phone:406-549-0267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT75538363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP37472Medicare UPIN
MDKR65Medicare ID - Type Unspecified