Provider Demographics
NPI:1124463641
Name:BREWSTER, LAURA JEAN (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:LAURA JEAN
Middle Name:
Last Name:BREWSTER
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 283
Mailing Address - Street 2:
Mailing Address - City:NIANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06357-0283
Mailing Address - Country:US
Mailing Address - Phone:860-385-4949
Mailing Address - Fax:860-410-4530
Practice Address - Street 1:8 W MAIN ST STE 1-3
Practice Address - Street 2:
Practice Address - City:NIANTIC
Practice Address - State:CT
Practice Address - Zip Code:06357-2330
Practice Address - Country:US
Practice Address - Phone:860-385-4949
Practice Address - Fax:860-410-4530
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5351363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health