Provider Demographics
NPI:1205933553
Name:BREWINGTON, DANA LUCAS (DPM)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:LUCAS
Last Name:BREWINGTON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:MRS
Other - First Name:DANA
Other - Middle Name:ROCHELLE
Other - Last Name:LUCAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7600 FRANCE AVE S STE 1100
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5924
Mailing Address - Country:US
Mailing Address - Phone:763-545-7545
Mailing Address - Fax:
Practice Address - Street 1:7600 FRANCE AVE S STE 1100
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5924
Practice Address - Country:US
Practice Address - Phone:952-926-3566
Practice Address - Fax:952-929-3358
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001063213E00000X
MN793213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0708630001Medicare NSC