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General NPI Number Information
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NPI Number | 1871518175
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Entity Type | Individual
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Provider Name | MICHAELYN MARIE BREWER PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 01/12/2015
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Provider Practice Location Address
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Address Line | 1130 N 204TH AVE
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City | ELKHORN
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State | NE
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Zip | 68022-1849
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Country | US
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Telephone | 402-758-5452
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Fax | 402-758-5398
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Provider Business Mailing Address
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Address Line | PO BOX 642117
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City | OMAHA
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State | NE
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Zip | 68164-8117
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Country | US
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Telephone | 402-398-6254
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Fax | 402-829-8513
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1140
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License Number State | NE
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