Healthcare Provider Details

I. General information

NPI: 1467087213
Provider Name (Legal Business Name): JANNEA MARIE BREWER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12001 BUSINESS BLVD
EAGLE RIVER AK
99577-7743
US

IV. Provider business mailing address

11432 HERITAGE CT APT 4
EAGLE RIVER AK
99577-7703
US

V. Phone/Fax

Practice location:
  • Phone: 907-694-6677
  • Fax:
Mailing address:
  • Phone: 907-671-8158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number116576
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: