MEDICARE: LA TESHA SHAREE BROWN MSN, BSN, RN

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	235Z00000X	Speech-Language Pathologist	9068	MN

General Provider Information

NPI Number	:	1801671953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LA TESHA SHAREE BROWN MSN, BSN, RN

Provider Business Mailing Address
First Line	:	357 VERNON ST APT 207
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94610-3053
Country	:	US
Telephone Number	:	408-931-2964
Fax Number	:

Provider Business Practice Location Address
First Line	:	3514 LYNDALE AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55412-2558
Country	:	US
Telephone Number	:	612-803-5038
Fax Number	:

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

Provider Enumeration Date	:	08/28/2023
Last Update Date	:	08/28/2023

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