Provider Demographics
NPI:1053067785
Name:BREWER, CHRISTINE NOELLE
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:NOELLE
Last Name:BREWER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 CECIL MALONE DR
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-5124
Mailing Address - Country:US
Mailing Address - Phone:607-252-7469
Mailing Address - Fax:
Practice Address - Street 1:138 CECIL MALONE DR
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5124
Practice Address - Country:US
Practice Address - Phone:607-252-7469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health