Healthcare Provider Details

I. General information

NPI: 1508640178
Provider Name (Legal Business Name): MAMIE SAWYER BREWER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2023
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 E RIDDLE AVE
RAVENNA OH
44266-3206
US

IV. Provider business mailing address

559 E RIDDLE AVE
RAVENNA OH
44266-3206
US

V. Phone/Fax

Practice location:
  • Phone: 330-346-3039
  • Fax:
Mailing address:
  • Phone: 440-506-5506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0043497
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN.463206
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: