Provider Demographics
NPI:1174037394
Name:BROWN, GERALDINE FELICIA
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:FELICIA
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 1:7121 MAYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-6510
Mailing Address - Country:US
Mailing Address - Phone:702-504-0606
Mailing Address - Fax:
Practice Address - Street 1:7121 MAYBROOK DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-6510
Practice Address - Country:US
Practice Address - Phone:702-504-0606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner