Provider Demographics
NPI:1962856179
Name:BREW, ODELIA
Entity type:Individual
Prefix:
First Name:ODELIA
Middle Name:
Last Name:BREW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ODELIA
Other - Middle Name:
Other - Last Name:BAAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, NP-C
Mailing Address - Street 1:378 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-6514
Mailing Address - Country:US
Mailing Address - Phone:860-335-4397
Mailing Address - Fax:860-792-8004
Practice Address - Street 1:378 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-6514
Practice Address - Country:US
Practice Address - Phone:860-335-4397
Practice Address - Fax:860-469-2322
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12.006638363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care