MEDICARE: TAWANDA 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	172V00000X	Community Health Worker	B6508178278109	WI

General Provider Information

NPI Number	:	1851623433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAWANDA BROWN

Provider Business Mailing Address
First Line	:	4451 N. 38 STREET
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-6137
Country	:	US
Telephone Number	:	414-837-9036
Fax Number	:

Provider Business Practice Location Address
First Line	:	4451 N 38TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-5911
Country	:	US
Telephone Number	:	414-837-9036
Fax Number	:

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

Provider Enumeration Date	:	02/05/2010
Last Update Date	:	02/05/2010

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Directions to “ TAWANDA BROWN ” Practice Location

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