Provider Demographics
NPI:1861721490
Name:BROWN, AYANNA (MS)
Entity type:Individual
Prefix:MS
First Name:AYANNA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 883
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95241-0883
Mailing Address - Country:US
Mailing Address - Phone:209-263-0632
Mailing Address - Fax:800-892-1659
Practice Address - Street 1:1819 S CHEROKEE LN APT 43
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-6362
Practice Address - Country:US
Practice Address - Phone:209-263-0632
Practice Address - Fax:800-892-1659
Is Sole Proprietor?:No
Enumeration Date:2009-12-10
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172A00000XOther Service ProvidersDriver