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General NPI Number Information
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NPI Number | 1689181372
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Entity Type | Individual
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Provider Name | TALETHA K BROWN APN
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Gender | Female
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Dates
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Enumeration Date | 01/04/2018
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Last Update Date | 04/25/2019
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Provider Practice Location Address
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Address Line | 3530 W PETERSON AVE STE 201
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City | CHICAGO
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State | IL
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Zip | 60659-3215
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Country | US
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Telephone | 773-839-5415
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Fax | 773-831-1706
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Provider Business Mailing Address
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Address Line | 304 QUEENS LN
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City | THORNTON
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State | IL
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Zip | 60476-1080
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Country | US
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Telephone | 708-564-5071
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209016986
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License Number State | IL
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