Healthcare Provider Details

I. General information

NPI: 1730296070
Provider Name (Legal Business Name): DONNA NEALOUS BROWN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 E PHILADELPHIA ST
DETROIT MI
48202-2224
US

IV. Provider business mailing address

400 E GRAND BLVD
DETROIT MI
48207-3619
US

V. Phone/Fax

Practice location:
  • Phone: 313-664-0661
  • Fax: 313-664-0661
Mailing address:
  • Phone: 313-579-5535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number4704229459
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: