Healthcare Provider Details

I. General information

NPI: 1386897239
Provider Name (Legal Business Name): ANITA YVONNE BROWN CDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2008
Last Update Date: 10/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 EXUMA DR.
ST. LOUIS MO
63136
US

IV. Provider business mailing address

1717 EXUMA DR.
ST. LOUIS MO
63136
US

V. Phone/Fax

Practice location:
  • Phone: 314-395-8085
  • Fax:
Mailing address:
  • Phone: 314-395-8085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: