Provider Demographics
NPI:1093303851
Name:BROWN, GALEN
Entity Type:Individual
Prefix:MS
First Name:GALEN
Middle Name:
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 1:815 BERKLEY AVE.
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-4450
Mailing Address - Country:US
Mailing Address - Phone:330-746-4539
Mailing Address - Fax:
Practice Address - Street 1:851 BERKLEY AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-3324
Practice Address - Country:US
Practice Address - Phone:330-518-1821
Practice Address - Fax:330-746-4539
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH293-11-23376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker