Healthcare Provider Details

I. General information

NPI: 1285956466
Provider Name (Legal Business Name): ASHLEY MATHIS BREWER R.D., L.D.N
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2010
Last Update Date: 02/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 S 10TH AVE
SILER CITY NC
27344-2779
US

IV. Provider business mailing address

4205 PINENEEDLE DR
GREENSBORO NC
27405-2937
US

V. Phone/Fax

Practice location:
  • Phone: 919-663-1744
  • Fax: 919-663-1635
Mailing address:
  • Phone: 336-382-0242
  • Fax: 919-663-1635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number977081
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: