Provider Demographics
NPI:1336645316
Name:BROWN, CHEREE NICOLE (HAIR LOSS SPECIALIST)
Entity Type:Individual
Prefix:
First Name:CHEREE
Middle Name:NICOLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1694 ALTA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38127-1302
Mailing Address - Country:US
Mailing Address - Phone:901-600-4831
Mailing Address - Fax:
Practice Address - Street 1:1391 ELVIS PRESLEY BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38106
Practice Address - Country:US
Practice Address - Phone:901-600-4831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1905541744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management