MEDICARE: TAMMY J BROWN STNA

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	376K00000X	Nurse's Aide	400784130708	OH

General Provider Information

NPI Number	:	1639410210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY J BROWN STNA

Provider Business Mailing Address
First Line	:	59 BRENNER AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45403-1121
Country	:	US
Telephone Number	:	937-718-5488
Fax Number	:

Provider Business Practice Location Address
First Line	:	59 BRENNER AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45403-1121
Country	:	US
Telephone Number	:	937-718-5488
Fax Number	:

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

Provider Enumeration Date	:	03/07/2013
Last Update Date	:	03/07/2013

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