Provider Demographics
NPI:1972712255
Name:BREWSTER-WILSON, PREMALA E (PHD)
Entity Type:Individual
Prefix:DR
First Name:PREMALA
Middle Name:E
Last Name:BREWSTER-WILSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1342 ATWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-2087
Mailing Address - Country:US
Mailing Address - Phone:301-460-6600
Mailing Address - Fax:301-460-6601
Practice Address - Street 1:1342 ATWOOD RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-2087
Practice Address - Country:US
Practice Address - Phone:301-460-6600
Practice Address - Fax:301-460-6601
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDN00051133N00000X
175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133N00000XDietary & Nutritional Service ProvidersNutritionist
Not Answered175L00000XOther Service ProvidersHomeopath