Provider Demographics
NPI:1518660372
Name:BREWSTER, ALISA E (LVN)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:E
Last Name:BREWSTER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11073 FAITH RD
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95965-9729
Mailing Address - Country:US
Mailing Address - Phone:151-087-5562
Mailing Address - Fax:
Practice Address - Street 1:3211 COHASSET RD STE 130
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-5403
Practice Address - Country:US
Practice Address - Phone:530-552-4627
Practice Address - Fax:530-879-3823
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA212500164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty