1346720489 NPI number — MRS. DIONNA ACHELLE BROWN CPRM

Table of content: MRS. DIONNA ACHELLE BROWN CPRM (NPI 1346720489)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346720489 NPI number — MRS. DIONNA ACHELLE BROWN CPRM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
DIONNA
Provider Middle Name:
ACHELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CPRM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRACEY
Provider Other First Name:
DIONNA
Provider Other Middle Name:
ACHELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CPRM
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1346720489
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2201 S GETTY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUSKEGON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49444-1207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-739-9315
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2201 S GETTY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUSKEGON HEIGHTS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49444-1207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-739-9315
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/17/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 175T00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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