Healthcare Provider Details

I. General information

NPI: 1336213982
Provider Name (Legal Business Name): KACYNDA MARSHALL BROWN CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6320 N BROAD ST
PHILADELPHIA PA
19141-2010
US

IV. Provider business mailing address

6320 N BROAD ST
PHILADELPHIA PA
19141-2010
US

V. Phone/Fax

Practice location:
  • Phone: 215-927-0926
  • Fax:
Mailing address:
  • Phone: 215-927-0926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number9968183
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: