Provider Demographics
NPI:1275016271
Name:BREWER, MEGAN SQUIRES (CRNA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:SQUIRES
Last Name:BREWER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:WOOD
Other - Last Name:SQUIRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 23467
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-3467
Mailing Address - Country:US
Mailing Address - Phone:864-590-0038
Mailing Address - Fax:
Practice Address - Street 1:25 COURTENAY DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-1004
Practice Address - Country:US
Practice Address - Phone:843-792-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2323546367500000X
NC6749367500000X
SC27789367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered