Provider Demographics
NPI:1093166167
Name:BROWN, CAROL NICOLE (CPC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:NICOLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1057 TRUMBULL AVE STE P
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-3489
Mailing Address - Country:US
Mailing Address - Phone:330-759-1210
Mailing Address - Fax:
Practice Address - Street 1:1057 TRUMBULL AVE STE P
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:OH
Practice Address - Zip Code:44420-3489
Practice Address - Country:US
Practice Address - Phone:330-759-1210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist