Provider Demographics
NPI:1326256876
Name:BREWER, MENDA MALIA (STNA)
Entity Type:Individual
Prefix:
First Name:MENDA
Middle Name:MALIA
Last Name:BREWER
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 MCKELL AVE
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45123-1556
Mailing Address - Country:US
Mailing Address - Phone:937-403-5139
Mailing Address - Fax:
Practice Address - Street 1:545 MCKELL AVE
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:OH
Practice Address - Zip Code:45123-1556
Practice Address - Country:US
Practice Address - Phone:937-403-5139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2681450374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide