Healthcare Provider Details

I. General information

NPI: 1487476875
Provider Name (Legal Business Name): AUTUMN W BROWN MA,PHLEBOTOMIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AUTUMN WENDY MCCLOUD-BROWN MA,PHLEBOTOMIST

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8917 W LAWRENCE AVE
MILWAUKEE WI
53225
US

IV. Provider business mailing address

6969 N PORT WASHINGTON RD SUITE B150
GLENDALE WI
53217
US

V. Phone/Fax

Practice location:
  • Phone: 262-336-1371
  • Fax:
Mailing address:
  • Phone: 262-336-1371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberH7Z3Y8Z4
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: