Provider Demographics
NPI:1689977266
Name:BREWER, STEPHANIE T (PA)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:T
Last Name:BREWER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 BORTHWICK AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801
Mailing Address - Country:US
Mailing Address - Phone:603-433-4075
Mailing Address - Fax:603-334-2048
Practice Address - Street 1:333 BORTHWICK AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7128
Practice Address - Country:US
Practice Address - Phone:603-433-4075
Practice Address - Fax:603-334-2048
Is Sole Proprietor?:No
Enumeration Date:2010-12-21
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0848363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3096165Medicaid
NHP01087925OtherRAILROAD MEDICARE
MAP00940089OtherRAILROAD MEDICARE
NH2063201Medicare PIN
MA0020632Medicare PIN