Provider Demographics
NPI:1790805448
Name:NELSON BREWER, BEATRICE ALEXANDRIA (MD)
Entity Type:Individual
Prefix:DR
First Name:BEATRICE
Middle Name:ALEXANDRIA
Last Name:NELSON BREWER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2377 E 70TH PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-2263
Mailing Address - Country:US
Mailing Address - Phone:773-851-6379
Mailing Address - Fax:
Practice Address - Street 1:4844 BROADWAY
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46408-4509
Practice Address - Country:US
Practice Address - Phone:219-985-2760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010345362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100202740AMedicaid
IN940060TMedicare ID - Type Unspecified
IN100202740AMedicaid