Healthcare Provider Details

I. General information

NPI: 1093978488
Provider Name (Legal Business Name): AMANDA JC BREWER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 01/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

6818 PEAKS EDGE DR APT 66
CINCINNATI OH
45247-3252
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-8011
  • Fax:
Mailing address:
  • Phone: 219-916-9143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number11014424A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207ZP0213X
TaxonomyPediatric Pathology Physician
License Number57.020276
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: