MEDICARE: MS. JOHNNIE MARIE BROWN PROGRAM MANAGER

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	177F00000X	Lodging Provider

General Provider Information

NPI Number	:	1841478997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOHNNIE MARIE BROWN PROGRAM MANAGER

Provider Business Mailing Address
First Line	:	28 MELANIE CT
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75603-9104
Country	:	US
Telephone Number	:	903-643-9385
Fax Number	:

Provider Business Practice Location Address
First Line	:	28 MELANIE CT
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75603-9104
Country	:	US
Telephone Number	:	903-643-9385
Fax Number	:

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

Provider Enumeration Date	:	01/31/2008
Last Update Date	:	01/31/2008

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