Provider Demographics
NPI:1396997086
Name:BREWER, ELAINE MARIE (LMP)
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:MARIE
Last Name:BREWER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 EDGEWATER WAY S
Mailing Address - Street 2:
Mailing Address - City:DESERT AIRE
Mailing Address - State:WA
Mailing Address - Zip Code:99349-1953
Mailing Address - Country:US
Mailing Address - Phone:509-929-1519
Mailing Address - Fax:509-932-5363
Practice Address - Street 1:210 GOVERNMENT RD.
Practice Address - Street 2:
Practice Address - City:MATTAWA
Practice Address - State:WA
Practice Address - Zip Code:99349
Practice Address - Country:US
Practice Address - Phone:509-929-1519
Practice Address - Fax:509-932-5363
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00006087225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist