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General NPI Number Information
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NPI Number | 1104742022
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Entity Type | Individual
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Provider Name | JASMINE NICOLE BREWER LDO
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Gender | Female
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Dates
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Enumeration Date | 06/25/2026
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Last Update Date | 06/25/2026
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Provider Practice Location Address
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Address Line | 468 TRADE CENTER LN
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City | JONESVILLE
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State | VA
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Zip | 24263-7463
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Country | US
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Telephone | 276-346-2876
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Fax | 276-346-2878
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Provider Business Mailing Address
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Address Line | 1200 TOBACCO RD
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City | JONESVILLE
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State | VA
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Zip | 24263-6785
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 1101004675
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License Number State | VA
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