MEDICARE: MELISSA ANN BREWER RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator	60445733102	UT

General Provider Information

NPI Number	:	1720355100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA ANN BREWER RN

Provider Business Mailing Address
First Line	:	650 KOMAS DR
Second Line	:	200
City	:	SLC
State	:	UT
Zip	:	84108-1215
Country	:	US
Telephone Number	:	801-587-3855
Fax Number	:	801-581-7989

Provider Business Practice Location Address
First Line	:	650 KOMAS DR
Second Line	:	200
City	:	SLC
State	:	UT
Zip	:	84108-1215
Country	:	US
Telephone Number	:	801-587-3855
Fax Number	:	801-581-7989

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2011
Last Update Date	:	11/29/2011

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