MEDICARE: MS. TAMIKA LYNETTE 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	374U00000X	Home Health Aide	334870810800	OH

General Provider Information

NPI Number	:	1295943405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TAMIKA LYNETTE BROWN

Provider Business Mailing Address
First Line	:	4047 MYRON AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45416-1657
Country	:	US
Telephone Number	:	937-274-0022
Fax Number	:	937-274-0022

Provider Business Practice Location Address
First Line	:	4047 MYRON AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45416-1657
Country	:	US
Telephone Number	:	937-274-0022
Fax Number	:	937-274-0022

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

Provider Enumeration Date	:	05/19/2007
Last Update Date	:	07/09/2007

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