Provider Demographics
NPI:1154044964
Name:BREWER, HALEY JANE (PA)
Entity type:Individual
Prefix:MRS
First Name:HALEY
Middle Name:JANE
Last Name:BREWER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:HALEY
Other - Middle Name:JANE
Other - Last Name:HINCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3880 SALEM LAKE DR STE F
Mailing Address - Street 2:
Mailing Address - City:LONG GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60047-5292
Mailing Address - Country:US
Mailing Address - Phone:847-719-2220
Mailing Address - Fax:847-719-2265
Practice Address - Street 1:22285 N PEPPER RD STE 302
Practice Address - Street 2:
Practice Address - City:LAKE BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-2541
Practice Address - Country:US
Practice Address - Phone:847-726-0774
Practice Address - Fax:847-277-1549
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.009231363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILMB7618789OtherDEA
IL085009231Medicaid