Provider Demographics
NPI:1619180056
Name:BREWER, ANGELA KAY (LPN)
Entity Type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:KAY
Last Name:BREWER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 BANKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-5788
Mailing Address - Country:US
Mailing Address - Phone:614-347-6650
Mailing Address - Fax:
Practice Address - Street 1:4191 FREDERICKSBURG AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-3502
Practice Address - Country:US
Practice Address - Phone:614-274-1652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN085016164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2582932Medicaid