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General NPI Number Information
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NPI Number | 1649811183
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Entity Type | Individual
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Provider Name | LANIECE J BROWN ATC
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Gender | Female
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Dates
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Enumeration Date | 10/07/2019
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | CAMPUS BOX 2660
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City | NORMAL
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State | IL
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Zip | 61790-2660
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Country | US
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Telephone | 309-438-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 N LINDEN ST APT K102
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City | NORMAL
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State | IL
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Zip | 61761-5324
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Country | US
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Telephone | 908-721-2056
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT9065
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 096.016140
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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