Healthcare Provider Details

I. General information

NPI: 1487517637
Provider Name (Legal Business Name): TAINUI BREWSTER
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 W 9000 S
SANDY UT
84070-2008
US

IV. Provider business mailing address

371 S 200 W APT 806
SALT LAKE CITY UT
84101-1880
US

V. Phone/Fax

Practice location:
  • Phone: 801-251-6077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number14246619-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: