Provider Demographics
NPI:1497422240
Name:BREWSTER, YDEIA (RN)
Entity Type:Individual
Prefix:
First Name:YDEIA
Middle Name:
Last Name:BREWSTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 WYNNEFIELD AVE
Mailing Address - Street 2:UNIT 108
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19131
Mailing Address - Country:US
Mailing Address - Phone:267-225-5965
Mailing Address - Fax:
Practice Address - Street 1:5050 WYNNEFIELD AVE
Practice Address - Street 2:UNIT 108
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19131
Practice Address - Country:US
Practice Address - Phone:267-225-5965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN611344163WH0200X
PARN742132163WH0200X
PARN654776163WH0200X
PARN557717163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health