Healthcare Provider Details

I. General information

NPI: 1093212839
Provider Name (Legal Business Name): RACHEL MARIE BREWER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 HERITAGE WAY STE 202
KALISPELL MT
59901-3127
US

IV. Provider business mailing address

150 COMMONS WAY
KALISPELL MT
59901-1910
US

V. Phone/Fax

Practice location:
  • Phone: 406-752-8433
  • Fax:
Mailing address:
  • Phone: 406-752-2010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number35608
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17065-33
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number132125
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: