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NPI Code Detail

MEDICARE: MS. TONYA BREWER NP

MEDICARE: MS. TONYA BREWER NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2200XAdult Health Nurse Practitioner4704231169MI
2363LG0600XGerontology Nurse Practitioner4704231169MI
3363LP2300XPrimary Care Nurse Practitioner4704231169MI

General Provider Information

NPI Number : 1790158251
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TONYA BREWER NP
Provider Business Mailing Address
First Line : 14671 TELEGRAPH RD
Second Line :
City : REDFORD
State : MI
Zip : 48239-3300
Country : US
Telephone Number : 313-948-3030
Fax Number :
Provider Business Practice Location Address
First Line : 14671 TELEGRAPH RD
Second Line :
City : REDFORD
State : MI
Zip : 48239-3300
Country : US
Telephone Number : 313-948-3030
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2015
Last Update Date : 11/05/2015

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