Healthcare Provider Details

I. General information

NPI: 1053770008
Provider Name (Legal Business Name): LLOYDETTE H BREWAH DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LLOYDETTE HAROLDA BREWAH DNP

II. Dates (important events)

Enumeration Date: 02/18/2016
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15110 S FORTUNA ROAD STE A
YUMA AZ
85367-7886
US

IV. Provider business mailing address

15110 S FORTUNA ROAD STE A
YUMA AZ
85367-7886
US

V. Phone/Fax

Practice location:
  • Phone: 928-342-7046
  • Fax:
Mailing address:
  • Phone: 951-269-0542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number338001
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number338001
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number338001
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: