Healthcare Provider Details

I. General information

NPI: 1528538469
Provider Name (Legal Business Name): MICHELLE BREWER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2018
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4110 US HIGHWAY 31 S
DECATUR AL
35603-1644
US

IV. Provider business mailing address

4110 US HIGHWAY 31 S
DECATUR AL
35603-1644
US

V. Phone/Fax

Practice location:
  • Phone: 304-280-4011
  • Fax:
Mailing address:
  • Phone: 304-280-4011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-170852
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: