Healthcare Provider Details

I. General information

NPI: 1952090763
Provider Name (Legal Business Name): STEPHANIE LYNN BREWER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE LYNN COLLEINS MD

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 01/13/2024
Certification Date: 01/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 BELLEAIRE AVE
SPRINGFIELD OH
45503-4831
US

IV. Provider business mailing address

306 BELLEAIRE AVE
SPRINGFIELD OH
45503-4831
US

V. Phone/Fax

Practice location:
  • Phone: 193-720-6178
  • Fax:
Mailing address:
  • Phone: 937-504-1617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number67447484336
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number67447484336
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: