Provider Demographics
NPI:1710654595
Name:BREWERTON, ERIKA (LPN)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:BREWERTON
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 1:207 BAYWAY DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-1403
Mailing Address - Country:US
Mailing Address - Phone:585-298-1725
Mailing Address - Fax:
Practice Address - Street 1:207 BAYWAY DR
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-1403
Practice Address - Country:US
Practice Address - Phone:585-298-1725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301018164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse