Provider Demographics
NPI:1841684412
Name:BREWER, CARIE J (NP)
Entity type:Individual
Prefix:
First Name:CARIE
Middle Name:J
Last Name:BREWER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7775985
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-5985
Mailing Address - Country:US
Mailing Address - Phone:317-770-6900
Mailing Address - Fax:317-770-6911
Practice Address - Street 1:14540 PRAIRIE LAKES BLVD N
Practice Address - Street 2:SUITE 102
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-4366
Practice Address - Country:US
Practice Address - Phone:317-770-9353
Practice Address - Fax:317-770-9358
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71005393A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201282830Medicaid
IN177280036Medicare PIN