Healthcare Provider Details

I. General information

NPI: 1730137449
Provider Name (Legal Business Name): NANCY A BREWSTER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8185 HIGHWAY 789
LANDER WY
82520-2942
US

IV. Provider business mailing address

8185 HIGHWAY 789
LANDER WY
82520-2942
US

V. Phone/Fax

Practice location:
  • Phone: 307-335-7555
  • Fax: 307-335-7999
Mailing address:
  • Phone: 307-335-7555
  • Fax: 307-335-7999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number171
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: