Provider Demographics
NPI:1326584996
Name:BROWN, DAVIDA ALICE
Entity Type:Individual
Prefix:
First Name:DAVIDA
Middle Name:ALICE
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 1:24128 MARIGOLD CT
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-3141
Mailing Address - Country:US
Mailing Address - Phone:586-625-6758
Mailing Address - Fax:
Practice Address - Street 1:24128 MARIGOLD CT
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-3141
Practice Address - Country:US
Practice Address - Phone:586-625-6758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other