Healthcare Provider Details

I. General information

NPI: 1669517371
Provider Name (Legal Business Name): DIANNA LYNN BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5277 COBBLEGATE BLVD APT I
DAYTON OH
45439-6111
US

IV. Provider business mailing address

5277 COBBLEGATE BLVD APT I
DAYTON OH
45439-6111
US

V. Phone/Fax

Practice location:
  • Phone: 937-396-6353
  • Fax:
Mailing address:
  • Phone: 937-396-6353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number2386065
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: