Healthcare Provider Details

I. General information

NPI: 1851804728
Provider Name (Legal Business Name): JUANITA ANN BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2017
Last Update Date: 11/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 FAIRCHILD CT
HAMPTON VA
23666-6028
US

IV. Provider business mailing address

4 FAIRCHILD CT
HAMPTON VA
23666-6028
US

V. Phone/Fax

Practice location:
  • Phone: 757-332-6000
  • Fax: 757-262-1278
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: