Healthcare Provider Details

I. General information

NPI: 1811712631
Provider Name (Legal Business Name): LANICE MONAET BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 STARRET ST
LANCASTER OH
43130-3993
US

IV. Provider business mailing address

566 N OHIO AVE
COLUMBUS OH
43203-1142
US

V. Phone/Fax

Practice location:
  • Phone: 740-687-0042
  • Fax:
Mailing address:
  • Phone: 614-362-1517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: