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General NPI Number Information
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NPI Number | 1659501203
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Entity Type | Individual
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Provider Name | SHANNON E. BREWSTER LVN
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Gender | Male
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Dates
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Enumeration Date | 07/16/2009
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Last Update Date | 07/16/2009
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Provider Practice Location Address
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Address Line | 10001 COUNTY FARM RD
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City | RIVERSIDE
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State | CA
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Zip | 92503-3507
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Country | US
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Telephone | 951-343-2536
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Fax | 951-729-3309
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Provider Business Mailing Address
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Address Line | 23288 WILD HORSE CT
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City | WILDOMAR
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State | CA
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Zip | 92595-7659
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | VN208396
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License Number State | CA
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