Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 26NJ00931900 | NJ |
NPI | 1013579598 |
---|---|
Provider Name | Debra J Brouwer |
First Address | Newark, NJ 07112-2027 |
Second Address | Newark, NJ 07112-2027 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2019 |
Last Update Date | 03/07/2019 |