Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 1-133796 | AL |
N | 363LW0102X | Nurse Practitioner - Women's Health | R859705 | MS |
NPI | 1003921263 |
---|---|
Provider Name | Mrs. Deah H. Brewer |
First Address | Chatom, AL 36518-6715 |
Second Address | Chatom, AL 36518-6715 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 29/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
06303269 | (05) | MS |