Provider Demographics
NPI:1407306889
Name:BREWER, HOLLY PESCHKEN (RD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:PESCHKEN
Last Name:BREWER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8851 MAGNOLIA ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-7847
Mailing Address - Country:US
Mailing Address - Phone:610-762-2466
Mailing Address - Fax:
Practice Address - Street 1:101 E WT HARRIS BLVD STE 2122B
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3485
Practice Address - Country:US
Practice Address - Phone:704-863-5713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered