Provider Demographics
NPI:1215010483
Name:BREWTON, MARCIA HIRSCH (NNP)
Entity Type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:HIRSCH
Last Name:BREWTON
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2668
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-2668
Mailing Address - Country:US
Mailing Address - Phone:985-230-6534
Mailing Address - Fax:985-230-6653
Practice Address - Street 1:15790 PAUL VEGA MD DR
Practice Address - Street 2:FINANCE DEPARTMENT
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1434
Practice Address - Country:US
Practice Address - Phone:985-230-6534
Practice Address - Fax:985-230-6653
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP01235363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1986640Medicaid