Healthcare Provider Details

I. General information

NPI: 1053985432
Provider Name (Legal Business Name): TAWANA BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15632 N 156TH LN
SURPRISE AZ
85374-8813
US

IV. Provider business mailing address

5350 W BELL RD STE C122
GLENDALE AZ
85308-3907
US

V. Phone/Fax

Practice location:
  • Phone: 602-601-8327
  • Fax:
Mailing address:
  • Phone: 602-601-8327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: