Provider Demographics
NPI:1063904407
Name:BREHMER, PETER NICHOLAS (FNP-BC)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:NICHOLAS
Last Name:BREHMER
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:PETER
Other - Middle Name:N
Other - Last Name:BREHMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, APRN, CNP
Mailing Address - Street 1:111 COUNTY ROAD 11 NW
Mailing Address - Street 2:
Mailing Address - City:PINE ISLAND
Mailing Address - State:MN
Mailing Address - Zip Code:55963-9756
Mailing Address - Country:US
Mailing Address - Phone:507-356-4929
Mailing Address - Fax:
Practice Address - Street 1:111 COUNTY ROAD 11 NW
Practice Address - Street 2:
Practice Address - City:PINE ISLAND
Practice Address - State:MN
Practice Address - Zip Code:55963-9756
Practice Address - Country:US
Practice Address - Phone:507-356-4929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-01
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT128792363LF0000X
CT7717363LP2300X
MN9421363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care