Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 46848 | CA |
NPI | 1477914083 |
---|---|
Provider Name | Lynnette Brewer |
First Address | Lodi, CA 95240-2048 |
Second Address | Lodi, CA 95240-2048 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2016 |
Last Update Date | 09/03/2016 |