Healthcare Provider Details

I. General information

NPI: 1083520993
Provider Name (Legal Business Name): RYAN BREWER LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22066 SW GRAHAMS FERRY RD APT C
TUALATIN OR
97062-8944
US

IV. Provider business mailing address

22066 SW GRAHAMS FERRY RD APT C
TUALATIN OR
97062-8944
US

V. Phone/Fax

Practice location:
  • Phone: 541-980-0079
  • Fax:
Mailing address:
  • Phone: 541-980-0079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number10061872
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: