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NPI Code Detail

MEDICARE: JILL MARION BREWER RDH

MEDICARE: JILL MARION BREWER RDH
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
1124Q00000XDental Hygienist0402204812VA

General Provider Information

NPI Number : 1942924014
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILL MARION BREWER RDH
Provider Business Mailing Address
First Line : 2500 N VAN DORN ST STE 128
Second Line :
City : ALEXANDRIA
State : VA
Zip : 22302-1601
Country : US
Telephone Number : 703-894-4867
Fax Number :
Provider Business Practice Location Address
First Line : 2500 N VAN DORN ST STE 128
Second Line :
City : ALEXANDRIA
State : VA
Zip : 22302-1601
Country : US
Telephone Number : 703-894-4867
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2022
Last Update Date : 10/03/2022

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Directions to “ JILL MARION BREWER RDH” Practice Location

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