=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760277388
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAPANGA BREWER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2025
-----------------------------------------------------
Last Update Date | 04/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 E MAIN ST
-----------------------------------------------------
City | ROWLAND
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28383-9400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-720-1101
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1631
-----------------------------------------------------
City | PEMBROKE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28372-1631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-544-7567
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175T00000X
-----------------------------------------------------
Taxonomy Name | Peer Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------