Provider Demographics
NPI:1528538469
Name:BREWER, MICHELLE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BREWER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15583 DON ANDERSON PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35444-0796
Mailing Address - Country:US
Mailing Address - Phone:304-280-4011
Mailing Address - Fax:
Practice Address - Street 1:15583 DON ANDERSON PKWY
Practice Address - Street 2:
Practice Address - City:BROOKWOOD
Practice Address - State:AL
Practice Address - Zip Code:35444-0796
Practice Address - Country:US
Practice Address - Phone:304-280-4011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-04
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-170852363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVE854875OtherDRIVERS LISENCE