Provider Demographics
NPI:1902522501
Name:BROWN, CARLA M
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18219 GLEN SWILLY CIR
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-3626
Mailing Address - Country:US
Mailing Address - Phone:708-407-6956
Mailing Address - Fax:
Practice Address - Street 1:18219 GLEN SWILLY CIR
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-3626
Practice Address - Country:US
Practice Address - Phone:708-407-6956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker