Healthcare Provider Details

I. General information

NPI: 1003723438
Provider Name (Legal Business Name): MRS. HAGEN ALYSSA BREWER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HAGEN ALYSSA JACOBS

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 S 6TH ST
MONTICELLO IN
47960-8182
US

IV. Provider business mailing address

815 S BARNES ST
BURNETTSVILLE IN
47926-8061
US

V. Phone/Fax

Practice location:
  • Phone: 574-583-1726
  • Fax:
Mailing address:
  • Phone: 574-870-4852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28256381A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: