Provider Demographics
NPI:1407197692
Name:BREWER, NATHALIE L (MD)
Entity Type:Individual
Prefix:MRS
First Name:NATHALIE
Middle Name:L
Last Name:BREWER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:NATHALIE
Other - Middle Name:L
Other - Last Name:BREWER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:43 WHITING HILL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1006
Mailing Address - Country:US
Mailing Address - Phone:207-973-5000
Mailing Address - Fax:
Practice Address - Street 1:489 STATE ST
Practice Address - Street 2:WEBBER EAST SUITE 305
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-973-8853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-13
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD211692086S0120X
OH57.022290390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program