Provider Demographics
NPI:1578988200
Name:BREWER, ERICA
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:BREWER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 LEMLEY DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ONEONTA
Mailing Address - State:AL
Mailing Address - Zip Code:35121-4631
Mailing Address - Country:US
Mailing Address - Phone:205-625-3561
Mailing Address - Fax:
Practice Address - Street 1:101 LEMLEY DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:ONEONTA
Practice Address - State:AL
Practice Address - Zip Code:35121-4631
Practice Address - Country:US
Practice Address - Phone:205-625-3561
Practice Address - Fax:205-274-9638
Is Sole Proprietor?:No
Enumeration Date:2014-03-05
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-106626363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily