Provider Demographics
NPI:1174822209
Name:HALL-BROWN, LATISA L (RN)
Entity Type:Individual
Prefix:MS
First Name:LATISA
Middle Name:L
Last Name:HALL-BROWN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:LATISA
Other - Middle Name:L
Other - Last Name:HALL-BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:37 FREEMAN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-2704
Mailing Address - Country:US
Mailing Address - Phone:716-931-3740
Mailing Address - Fax:
Practice Address - Street 1:37 FREEMAN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-2704
Practice Address - Country:US
Practice Address - Phone:716-931-3740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22 577893163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse