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General NPI Number Information
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NPI Number | 1124686431
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Entity Type | Individual
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Provider Name | TIFFANY LA'SHAE BROWN
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Gender | Female
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Dates
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Enumeration Date | 05/31/2019
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Last Update Date | 05/31/2019
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Provider Practice Location Address
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Address Line | 716 30TH ST NW APT 214
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City | CANTON
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State | OH
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Zip | 44709-3162
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Country | US
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Telephone | 234-215-1859
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Fax |
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Provider Business Mailing Address
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Address Line | 3712 MARTINDALE RD NE APT E
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City | CANTON
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State | OH
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Zip | 44714-1357
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Country | US
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Telephone | 234-521-2242
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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