Healthcare Provider Details

I. General information

NPI: 1386110708
Provider Name (Legal Business Name): JAMIE THERSE BREWER APRN-CS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 E STATE ST FL 4
ROCKFORD IL
61104-2315
US

IV. Provider business mailing address

2560 24TH ST STE 101
ROCK ISLAND IL
61201-5389
US

V. Phone/Fax

Practice location:
  • Phone: 779-696-4123
  • Fax:
Mailing address:
  • Phone: 309-779-3970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number309013502
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number209018120
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number377002908
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number309.013502
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: