Healthcare Provider Details

I. General information

NPI: 1467948133
Provider Name (Legal Business Name): NATALIE SUZANNE BREWSTER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATALIE SUZANNE GARRICK PA

II. Dates (important events)

Enumeration Date: 07/06/2018
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2066 HUDSON AVE
ROCHESTER NY
14617-4300
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-2800
  • Fax:
Mailing address:
  • Phone: 585-922-0553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number022314
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: