MEDICARE: TIFFANY LORIECE 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	374J00000X	Doula		MO

General Provider Information

NPI Number	:	1295503159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY LORIECE BROWN

Provider Business Mailing Address
First Line	:	1440 E PRAIRIE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63107-1229
Country	:	US
Telephone Number	:	314-226-0420
Fax Number	:

Provider Business Practice Location Address
First Line	:	1440 E PRAIRIE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63107-1229
Country	:	US
Telephone Number	:	314-226-0420
Fax Number	:

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

Provider Enumeration Date	:	12/19/2023
Last Update Date	:	12/20/2023

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Directions to “ TIFFANY LORIECE BROWN ” Practice Location

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