Healthcare Provider Details

I. General information

NPI: 1821399312
Provider Name (Legal Business Name): RENAE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2010
Last Update Date: 11/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 W NORTH AVE
BALTIMORE MD
21217-1610
US

IV. Provider business mailing address

1845 W NORTH AVE
BALTIMORE MD
21217-1610
US

V. Phone/Fax

Practice location:
  • Phone: 347-369-6122
  • Fax: 443-438-7481
Mailing address:
  • Phone: 347-369-6122
  • Fax: 443-438-7481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberA00081048
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: