Provider Demographics
NPI:1164751483
Name:BREWER, CARMEN E (NURSE)
Entity Type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:E
Last Name:BREWER
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 TOWNHOUSE RD N
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-1237
Mailing Address - Country:US
Mailing Address - Phone:631-923-0117
Mailing Address - Fax:
Practice Address - Street 1:60 TOWNHOUSE ROAD NORTH
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-1237
Practice Address - Country:US
Practice Address - Phone:631-923-0117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299046164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse