MEDICARE: GINA BROWN IHP2

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	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1881430411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA BROWN IHP2

Provider Business Mailing Address
First Line	:	PO BOX 235
Second Line	:
City	:	PORTLAND
State	:	TX
Zip	:	78374-0235
Country	:	US
Telephone Number	:	361-233-3100
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 SAN SABA DR
Second Line	:
City	:	PORTLAND
State	:	TX
Zip	:	78374-1456
Country	:	US
Telephone Number	:	361-233-3100
Fax Number	:

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

Provider Enumeration Date	:	07/03/2024
Last Update Date	:	07/03/2024

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