Provider Demographics
NPI:1407127350
Name:BREWER, SHARHONDA L (BS)
Entity Type:Individual
Prefix:
First Name:SHARHONDA
Middle Name:L
Last Name:BREWER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 NW KINGSBURY AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73507-3735
Mailing Address - Country:US
Mailing Address - Phone:580-248-6322
Mailing Address - Fax:
Practice Address - Street 1:1810 NW KINGSBURY AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73507-3735
Practice Address - Country:US
Practice Address - Phone:580-248-6322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor