Provider Demographics
NPI:1265983399
Name:BREWER, AMELIA JANELE (BA)
Entity type:Individual
Prefix:MRS
First Name:AMELIA
Middle Name:JANELE
Last Name:BREWER
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 NW 164TH CIR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-1681
Mailing Address - Country:US
Mailing Address - Phone:405-830-8141
Mailing Address - Fax:
Practice Address - Street 1:2401 NW 23RD ST STE 101
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-2431
Practice Address - Country:US
Practice Address - Phone:405-595-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program