Healthcare Provider Details

I. General information

NPI: 1407099989
Provider Name (Legal Business Name): CRISTIE MAY NAMATA BREWER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8081 INNOVATION PARK DR STE 900
FAIRFAX VA
22031-4867
US

IV. Provider business mailing address

3300 GALLOWS RD DEPT. OF NEUROSCIENCES, NPT 2ND FLOOR
FALLS CHURCH VA
22042-3307
US

V. Phone/Fax

Practice location:
  • Phone: 571-472-4100
  • Fax: 571-472-4101
Mailing address:
  • Phone: 703-776-8310
  • Fax: 703-776-4018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024168273
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License NumberAC000689
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code364SN0800X
TaxonomyNeuroscience Clinical Nurse Specialist
License Number0024168273
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: