Provider Demographics
NPI:1285809780
Name:BREWER, PATRISHA A
Entity type:Individual
Prefix:MRS
First Name:PATRISHA
Middle Name:A
Last Name:BREWER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:PATRISHA
Other - Middle Name:A
Other - Last Name:BREWER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:6206 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-5179
Mailing Address - Country:US
Mailing Address - Phone:937-743-9162
Mailing Address - Fax:
Practice Address - Street 1:6206 CEDAR LN
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-5179
Practice Address - Country:US
Practice Address - Phone:937-743-9162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.077844164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2218997Medicare PIN