Provider Demographics
NPI:1043809759
Name:BROWN, TESTLEY (RN)
Entity Type:Individual
Prefix:
First Name:TESTLEY
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 S HOOD ST
Mailing Address - Street 2:
Mailing Address - City:OLANTA
Mailing Address - State:SC
Mailing Address - Zip Code:29114-9496
Mailing Address - Country:US
Mailing Address - Phone:843-373-9624
Mailing Address - Fax:
Practice Address - Street 1:541 S HOOD ST
Practice Address - Street 2:
Practice Address - City:OLANTA
Practice Address - State:SC
Practice Address - Zip Code:29114-9496
Practice Address - Country:US
Practice Address - Phone:843-373-9624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-16
Last Update Date:2021-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC218764163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0400XNursing Service ProvidersRegistered NurseRehabilitation