Provider Demographics
NPI:1134493950
Name:BREWER, SHIRLEY A (RN)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:A
Last Name:BREWER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 S 17TH PL
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-7508
Mailing Address - Country:US
Mailing Address - Phone:920-287-9946
Mailing Address - Fax:
Practice Address - Street 1:3920 S 17TH PL
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-7508
Practice Address - Country:US
Practice Address - Phone:920-287-9946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI122324-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse