MEDICARE: VICKI BROWN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency	RQ189085	OH

General Provider Information

NPI Number	:	1073116430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKI BROWN

Provider Business Mailing Address
First Line	:	1508 BROOKFIELD LN
Second Line	:
City	:	TROY
State	:	OH
Zip	:	45373-1160
Country	:	US
Telephone Number	:	937-405-8573
Fax Number	:

Provider Business Practice Location Address
First Line	:	1508 BROOKFIELD LN
Second Line	:
City	:	TROY
State	:	OH
Zip	:	45373-1160
Country	:	US
Telephone Number	:	937-405-8573
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2020
Last Update Date	:	11/18/2020

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Directions to “ VICKI BROWN ” Practice Location

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