MEDICARE: CHEROKEE ROSE 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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1649778887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHEROKEE ROSE BROWN

Provider Business Mailing Address
First Line	:	PO BOX 12
Second Line	:
City	:	SAINT STEPHENS
State	:	WY
Zip	:	82524-0012
Country	:	US
Telephone Number	:	307-856-0470
Fax Number	:	307-857-4383

Provider Business Practice Location Address
First Line	:	24 GREAT PLAINS RD
Second Line	:
City	:	ARAPAHOE
State	:	WY
Zip	:	82510-0024
Country	:	US
Telephone Number	:	307-856-0470
Fax Number	:	307-857-4383

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

Provider Enumeration Date	:	01/23/2018
Last Update Date	:	03/17/2018

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Directions to “ CHEROKEE ROSE BROWN ” Practice Location

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