Provider Demographics
NPI:1992027171
Name:BREWER, ELIZABETH SUSANNE (MS,RD,LD/N)
Entity Type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:SUSANNE
Last Name:BREWER
Suffix:
Gender:F
Credentials:MS,RD,LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 PINE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-3900
Mailing Address - Country:US
Mailing Address - Phone:239-304-4711
Mailing Address - Fax:239-304-4990
Practice Address - Street 1:6101 PINE RIDGE RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-3900
Practice Address - Country:US
Practice Address - Phone:239-304-4711
Practice Address - Fax:239-304-4990
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND5631133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered