Healthcare Provider Details

I. General information

NPI: 1932931102
Provider Name (Legal Business Name): CASE EDWARD BREWER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2024
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W NORTH AVE
MELROSE PARK IL
60160-1612
US

IV. Provider business mailing address

7006 PREMONT DR
CORPUS CHRISTI TX
78414-3120
US

V. Phone/Fax

Practice location:
  • Phone: 888-584-7888
  • Fax:
Mailing address:
  • Phone: 575-791-9705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209035761
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041545307
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: