Provider Demographics
NPI:1457800773
Name:BREWER, LESLIE GRAHAM (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:GRAHAM
Last Name:BREWER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5121 SELKIRK DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-4129
Mailing Address - Country:US
Mailing Address - Phone:205-873-2133
Mailing Address - Fax:
Practice Address - Street 1:5121 SELKIRK DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-4129
Practice Address - Country:US
Practice Address - Phone:205-873-2133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-135979363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily