MEDICARE: MRS. ANNIE MARIE BROWN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1093286684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNIE MARIE BROWN

Provider Business Mailing Address
First Line	:	4208 SAINT JULIANA ST
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71302-5313
Country	:	US
Telephone Number	:	318-880-1294
Fax Number	:

Provider Business Practice Location Address
First Line	:	4208 SAINT JULIANA ST
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71302-5313
Country	:	US
Telephone Number	:	318-880-1294
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2018
Last Update Date	:	12/08/2018

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