Healthcare Provider Details

I. General information

NPI: 1811859549
Provider Name (Legal Business Name): COURTNEY LYNN BREWSTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 N WALNUT ST
SOUTH BLOOMFIELD OH
43103-1018
US

IV. Provider business mailing address

1374 W 6TH AVE
COLUMBUS OH
43212-2406
US

V. Phone/Fax

Practice location:
  • Phone: 740-983-0015
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN.CNP.0038611
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: