Provider Demographics
NPI:1144655424
Name:BROWN-LEE, VIOLA
Entity type:Individual
Prefix:
First Name:VIOLA
Middle Name:
Last Name:BROWN-LEE
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 1:2301 W NORTHERN AVE
Mailing Address - Street 2:COMMUNITY MEDICAL SERVICES-NORTHERN
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-4918
Mailing Address - Country:US
Mailing Address - Phone:602-866-9378
Mailing Address - Fax:
Practice Address - Street 1:2301 W NORTHERN AVE
Practice Address - Street 2:COMMUNITY MEDICAL SERVICES-NORTHERN
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-4918
Practice Address - Country:US
Practice Address - Phone:602-866-9378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP005104164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse