Provider Demographics
NPI:1073217840
Name:BROWN, STEPHANIE FENAE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:FENAE
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 504
Mailing Address - Street 2:
Mailing Address - City:PLAIN DEALING
Mailing Address - State:LA
Mailing Address - Zip Code:71064-0504
Mailing Address - Country:US
Mailing Address - Phone:318-540-4731
Mailing Address - Fax:
Practice Address - Street 1:315 CRABAPPLE AVE
Practice Address - Street 2:
Practice Address - City:PLAIN DEALING
Practice Address - State:LA
Practice Address - Zip Code:71064-4401
Practice Address - Country:US
Practice Address - Phone:318-540-4731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA010397431172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver