Provider Demographics
NPI:1184870313
Name:BREWER, DIANE ELIZABETH (RNP)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:ELIZABETH
Last Name:BREWER
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-4017
Mailing Address - Country:US
Mailing Address - Phone:870-239-8503
Mailing Address - Fax:870-236-1947
Practice Address - Street 1:1 MEDICAL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4017
Practice Address - Country:US
Practice Address - Phone:870-239-8503
Practice Address - Fax:870-236-1947
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR13386163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR770246558OtherBREASTCARE PROGRAM