Healthcare Provider Details

I. General information

NPI: 1972982288
Provider Name (Legal Business Name): BRIANNA MEW D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2015
Last Update Date: 03/29/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 N RESERVE ST STE 402
MISSOULA MT
59808-1364
US

IV. Provider business mailing address

PO BOX 808
SPOKANE WA
99210-0808
US

V. Phone/Fax

Practice location:
  • Phone: 406-493-3120
  • Fax:
Mailing address:
  • Phone: 509-935-6001
  • Fax: 509-935-4196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMED-PHYS-LIC-66806
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: