Healthcare Provider Details

I. General information

NPI: 1659202463
Provider Name (Legal Business Name): RONNITA BROWN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28171 CAMPBELL DR
WARREN MI
48093-4901
US

IV. Provider business mailing address

28171 CAMPBELL DR
WARREN MI
48093-4901
US

V. Phone/Fax

Practice location:
  • Phone: 248-739-0528
  • Fax: 248-739-0528
Mailing address:
  • Phone: 248-739-0528
  • Fax: 248-739-0528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704343541
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: