Provider Demographics
NPI:1386110708
Name:BREWER, JAMIE THERSE (APRN-CS)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:THERSE
Last Name:BREWER
Suffix:
Gender:F
Credentials:APRN-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 S CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61312-9136
Mailing Address - Country:US
Mailing Address - Phone:815-440-9705
Mailing Address - Fax:
Practice Address - Street 1:1401 E STATE ST FL 4
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104-2315
Practice Address - Country:US
Practice Address - Phone:779-696-4123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2024-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL309.0135022084B0040X
IL3090135022084P0800X
IL2090181202084P0800X
IL377002908363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry