Healthcare Provider Details

I. General information

NPI: 1831443977
Provider Name (Legal Business Name): DENISE MARIE BREHMER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2012
Last Update Date: 03/19/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 E DEWEY ST
LOGANSPORT IN
46947-4933
US

IV. Provider business mailing address

99 E DEWEY ST
LOGANSPORT IN
46947-4933
US

V. Phone/Fax

Practice location:
  • Phone: 765-475-6963
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71004191A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: