Provider Demographics
NPI:1205313350
Name:BREWER, LATONDA T (AAS, BS, BA)
Entity type:Individual
Prefix:MS
First Name:LATONDA
Middle Name:T
Last Name:BREWER
Suffix:
Gender:F
Credentials:AAS, BS, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 CONE CT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-4314
Mailing Address - Country:US
Mailing Address - Phone:937-315-7638
Mailing Address - Fax:937-889-8496
Practice Address - Street 1:3900 CONE CT
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417
Practice Address - Country:US
Practice Address - Phone:937-889-8496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-22
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide