Provider Demographics
NPI:1487707147
Name:BREWER, PAUL EDWARD (CRNA)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:EDWARD
Last Name:BREWER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3169
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-0169
Mailing Address - Country:US
Mailing Address - Phone:812-237-0211
Mailing Address - Fax:812-237-0182
Practice Address - Street 1:7N THE MEADOWS SHOPPING CENTER
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803-2373
Practice Address - Country:US
Practice Address - Phone:812-237-0211
Practice Address - Fax:812-237-0182
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-354753367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN2001001050Medicaid
IN2001001050Medicaid