Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 63142-020 | WI |
NPI | 1225155641 |
---|---|
Provider Name | Dr. Amy H. Brewster |
First Address | Neenah, WI 54956-2526 |
Second Address | Neenah, WI 54956-2526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 26/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
K400193988 | MEDICARE (01) | WI |