Provider Demographics
NPI:1932962826
Name:BREWER, DANELLE DAVILA (RN ADN)
Entity Type:Individual
Prefix:MRS
First Name:DANELLE
Middle Name:DAVILA
Last Name:BREWER
Suffix:
Gender:F
Credentials:RN ADN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2665 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-3617
Mailing Address - Country:US
Mailing Address - Phone:210-800-3653
Mailing Address - Fax:
Practice Address - Street 1:22 S STATE ST
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-1043
Practice Address - Country:US
Practice Address - Phone:801-525-5078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12642094-3102163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health