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NPI Code Detail

MEDICARE: OLIVIA BREWER

MEDICARE: OLIVIA BREWER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse1006857TX

General Provider Information

NPI Number : 1205439783
Entity Type Code : Individual
Provider Name (Legal Business Name) : OLIVIA BREWER
Provider Business Mailing Address
First Line : 6041 VILLAGE BEND DR APT 109
Second Line :
City : DALLAS
State : TX
Zip : 75206-3602
Country : US
Telephone Number : 469-420-8025
Fax Number :
Provider Business Practice Location Address
First Line : 6041 VILLAGE BEND DR APT 109
Second Line :
City : DALLAS
State : TX
Zip : 75206-3602
Country : US
Telephone Number : 469-420-8025
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2020
Last Update Date : 11/18/2020

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Directions to “ OLIVIA BREWER ” Practice Location

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