Healthcare Provider Details

I. General information

NPI: 1285106559
Provider Name (Legal Business Name): STEPHANIE ANNE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2018
Last Update Date: 12/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 E WASHINGTON LN
PHILADELPHIA PA
19144-2011
US

IV. Provider business mailing address

142 E WASHINGTON LN
PHILADELPHIA PA
19144-2011
US

V. Phone/Fax

Practice location:
  • Phone: 818-939-1366
  • Fax:
Mailing address:
  • Phone: 818-939-1366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-137660
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: