Provider Demographics
NPI:1609428747
Name:BREWER, TEIAIRRA (STNA)
Entity Type:Individual
Prefix:
First Name:TEIAIRRA
Middle Name:
Last Name:BREWER
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3915 33RD ST NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44705-4942
Mailing Address - Country:US
Mailing Address - Phone:330-265-4559
Mailing Address - Fax:
Practice Address - Street 1:3915 33RD ST NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44705-4942
Practice Address - Country:US
Practice Address - Phone:330-265-4559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401913821116376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty