Provider Demographics
NPI:1972774230
Name:BREWER, MATTHEW JEREMY (RN)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:JEREMY
Last Name:BREWER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 E 127TH DR
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-3162
Mailing Address - Country:US
Mailing Address - Phone:720-771-2817
Mailing Address - Fax:
Practice Address - Street 1:2333 E 127TH DR
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80241-3162
Practice Address - Country:US
Practice Address - Phone:720-771-2817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO178794163W00000X, 163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WE0003XNursing Service ProvidersRegistered NurseEmergency