Provider Demographics
NPI:1831692839
Name:BROWN, ANGELINA MARIE
Entity type:Individual
Prefix:
First Name:ANGELINA
Middle Name:MARIE
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 1:349 WESTMEADE DR
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7207
Mailing Address - Country:US
Mailing Address - Phone:504-249-9378
Mailing Address - Fax:504-910-8638
Practice Address - Street 1:349 WESTMEADE DR
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-7207
Practice Address - Country:US
Practice Address - Phone:504-249-9378
Practice Address - Fax:504-910-8638
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA008109913172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver