Healthcare Provider Details

I. General information

NPI: 1922135250
Provider Name (Legal Business Name): MONICA M BREWSTER APRN, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 03/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 WASHINGTON STREET
NORWICH CT
06360
US

IV. Provider business mailing address

3998 FAIR RIDGE DR., SUITE 300 ATT CREDENTIALING
FAIRFAX VA
22033-2921
US

V. Phone/Fax

Practice location:
  • Phone: 860-889-8331
  • Fax:
Mailing address:
  • Phone: 703-295-9360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number002106
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: