Healthcare Provider Details

I. General information

NPI: 1225155641
Provider Name (Legal Business Name): AMY H. BREWSTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 S COMMERCIAL ST
NEENAH WI
54956-2526
US

IV. Provider business mailing address

425 S COMMERCIAL ST
NEENAH WI
54956-2526
US

V. Phone/Fax

Practice location:
  • Phone: 920-725-0700
  • Fax: 920-725-7978
Mailing address:
  • Phone: 920-725-0700
  • Fax: 920-725-7978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number63142-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: