Provider Demographics
NPI:1154940260
Name:BREWER, OLIVIA (APRN-CNM)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:BREWER
Suffix:
Gender:F
Credentials:APRN-CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 LILLIAN GISH BLVD SW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44647-6587
Mailing Address - Country:US
Mailing Address - Phone:330-809-0460
Mailing Address - Fax:
Practice Address - Street 1:2022 LEWIS DR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-6124
Practice Address - Country:US
Practice Address - Phone:330-242-0844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-005035207V00000X
OHAPRN.CNM.0019474367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology