Individual
MARK BREW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3120 MIDLAND VALLEY ST, NORMAN, OK 73069-6970
(614) 943-1041
Mailing address
5520 MESA RIDGE LN, COLUMBUS, OH 43231-6731
(614) 625-6486
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
PN.133673-M-IV
OH
363LF0000X
Family Nurse Practitioner
Primary
209311
OK
Other
Enumeration date
06/11/2011
Last updated
07/20/2022
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