Provider Demographics
NPI:1114294238
Name:BROWN, LISA
Entity Type:Individual
Prefix:MISS
First Name:LISA
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 1:5794 E JEFFERSON COMMONS CIR
Mailing Address - Street 2:APT 207
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-6038
Mailing Address - Country:US
Mailing Address - Phone:231-214-7263
Mailing Address - Fax:
Practice Address - Street 1:5990 VENTURE PARK
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-1858
Practice Address - Country:US
Practice Address - Phone:269-532-1470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner