Provider Demographics
NPI:1497994867
Name:BREWER, TAMMY SUE (CNA 1 & 2)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:SUE
Last Name:BREWER
Suffix:
Gender:F
Credentials:CNA 1 & 2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 SAINT CHARLES CT
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NC
Mailing Address - Zip Code:28658-3800
Mailing Address - Country:US
Mailing Address - Phone:704-881-3791
Mailing Address - Fax:
Practice Address - Street 1:1108 SAINT CHARLES CT
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NC
Practice Address - Zip Code:28658-3800
Practice Address - Country:US
Practice Address - Phone:704-881-3791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC56103172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker