Provider Demographics
NPI:1093552572
Name:BREWER, DAVID JOSEPH-DEWAYNE
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JOSEPH-DEWAYNE
Last Name:BREWER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7722 GATHINGS DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46816-2759
Mailing Address - Country:US
Mailing Address - Phone:260-241-2425
Mailing Address - Fax:
Practice Address - Street 1:3132 E WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46803-1536
Practice Address - Country:US
Practice Address - Phone:260-310-9699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist