Healthcare Provider Details

I. General information

NPI: 1962677997
Provider Name (Legal Business Name): QIYAMAH BROWN FARMER RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9441 LBJ FWY 101
DALLAS TX
75243-4545
US

IV. Provider business mailing address

12325 OCEAN SPRAY DR
FRISCO TX
75034-0343
US

V. Phone/Fax

Practice location:
  • Phone: 186-657-5982
  • Fax:
Mailing address:
  • Phone: 972-827-5467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: