Provider Demographics
NPI:1124420062
Name:BREWER, CASSANDRA MONIC
Entity type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:MONIC
Last Name:BREWER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 N BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:OH
Mailing Address - Zip Code:45067-9613
Mailing Address - Country:US
Mailing Address - Phone:513-393-6225
Mailing Address - Fax:
Practice Address - Street 1:307 N BRANCH DR
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:OH
Practice Address - Zip Code:45067-9613
Practice Address - Country:US
Practice Address - Phone:513-393-6225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0104281Medicaid