Healthcare Provider Details

I. General information

NPI: 1568031029
Provider Name (Legal Business Name): LATOSHA MICHELLE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 07/21/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W GREENLAWN AVE
LANSING MI
48910-2898
US

IV. Provider business mailing address

405 E GREENLAWN AVE
LANSING MI
48910
US

V. Phone/Fax

Practice location:
  • Phone: 517-657-2638
  • Fax:
Mailing address:
  • Phone: 517-657-2638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: