Healthcare Provider Details

I. General information

NPI: 1841684412
Provider Name (Legal Business Name): CARIE J BREWER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 09/18/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14540 PRAIRIE LAKES BLVD N SUITE 102
NOBLESVILLE IN
46060-4366
US

IV. Provider business mailing address

PO BOX 7775985
CHICAGO IL
60677-5985
US

V. Phone/Fax

Practice location:
  • Phone: 317-770-9353
  • Fax: 317-770-9358
Mailing address:
  • Phone: 317-770-6900
  • Fax: 317-770-6911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71005393A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: