Provider Demographics
NPI:1649447715
Name:BREVER, LIBBY M (MD)
Entity type:Individual
Prefix:
First Name:LIBBY
Middle Name:M
Last Name:BREVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LIBBY
Other - Middle Name:M
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:MN
Mailing Address - Zip Code:56307-9379
Mailing Address - Country:US
Mailing Address - Phone:320-845-2157
Mailing Address - Fax:320-845-6138
Practice Address - Street 1:30 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:MN
Practice Address - Zip Code:56307-9379
Practice Address - Country:US
Practice Address - Phone:320-845-2157
Practice Address - Fax:320-845-6138
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN52115207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine