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General NPI Number Information
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NPI Number | 1689173791
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Entity Type | Individual
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Provider Name | KAREN BROWN HAIR REPLACEMENT SPE
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Gender | Female
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Dates
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Enumeration Date | 02/04/2018
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Last Update Date | 02/04/2018
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Provider Practice Location Address
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Address Line | 921 E PARKER ST STE 2
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City | LAKELAND
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State | FL
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Zip | 33801-1901
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Country | US
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Telephone | 863-688-1234
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Fax |
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Provider Business Mailing Address
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Address Line | 921 E PARKER ST STE 2
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City | LAKELAND
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State | FL
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Zip | 33801-1901
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Country | US
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Telephone | 863-688-1234
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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 | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number | CL0184292
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License Number State | FL
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