Provider Demographics
NPI:1962742825
Name:BREWER, SARA BETH
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:BETH
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 1:4706 PRIVATE ROAD 2326
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:MO
Mailing Address - Zip Code:65789-9518
Mailing Address - Country:US
Mailing Address - Phone:417-372-0001
Mailing Address - Fax:417-255-8799
Practice Address - Street 1:408 WASHINGTON AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-3432
Practice Address - Country:US
Practice Address - Phone:417-255-8782
Practice Address - Fax:417-255-8799
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor