Healthcare Provider Details

I. General information

NPI: 1619455110
Provider Name (Legal Business Name): DAMITA N BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2018
Last Update Date: 08/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 EUCLID AVE
AKRON OH
44307-2103
US

IV. Provider business mailing address

512 EUCLID AVE
AKRON OH
44307-2103
US

V. Phone/Fax

Practice location:
  • Phone: 330-606-9062
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: