Provider Demographics
NPI:1750628392
Name:BREWSTER, LEANORA (LPN)
Entity Type:Individual
Prefix:
First Name:LEANORA
Middle Name:
Last Name:BREWSTER
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 1:493 WILLIAMS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-5105
Mailing Address - Country:US
Mailing Address - Phone:718-342-6684
Mailing Address - Fax:718-347-4643
Practice Address - Street 1:493 WILLIAMS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-5105
Practice Address - Country:US
Practice Address - Phone:718-342-6684
Practice Address - Fax:718-347-4643
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308222164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse