Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | 95003681 | CA |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 95003681 | CA |
N | 363LP2300X | Nurse Practitioner - Primary Care | 95003681 | CA |
NPI | 1053770008 |
---|---|
Provider Name | Lloydette H Brewah |
First Address | Moreno Valley, CA 92553-5009 |
Second Address | Moreno Valley, CA 92553-5009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2016 |
Last Update Date | 17/01/2020 |