Provider Demographics
NPI:1053770008
Name:BREWAH, LLOYDETTE H (DNP)
Entity type:Individual
Prefix:
First Name:LLOYDETTE
Middle Name:H
Last Name:BREWAH
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:DR
Other - First Name:LLOYDETTE
Other - Middle Name:HAROLDA
Other - Last Name:BREWAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP
Mailing Address - Street 1:14934 TARRAGON WAY
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-5009
Mailing Address - Country:US
Mailing Address - Phone:951-269-0542
Mailing Address - Fax:
Practice Address - Street 1:14934 TARRAGON WAY
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-5009
Practice Address - Country:US
Practice Address - Phone:951-269-0542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-18
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003681363LA2200X, 363LP2300X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care