=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720889793
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BOND OLIVIA BREWSTER PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2025
-----------------------------------------------------
Last Update Date | 03/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7590 AUBURN RD
-----------------------------------------------------
City | CONCORD TOWNSHIP
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44077-9176
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-375-8100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8645 AUBURN RD
-----------------------------------------------------
City | CHARDON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44024-8711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-525-4170
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 50.009103RX
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------