Provider Demographics
NPI:1376761106
Name:BROWN, TERRI MICHELLE (NP)
Entity Type:Individual
Prefix:MS
First Name:TERRI
Middle Name:MICHELLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:9350 ROSEMONT AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-1835
Mailing Address - Country:US
Mailing Address - Phone:131-383-6606
Mailing Address - Fax:131-391-6917
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:131-391-6763
Practice Address - Fax:131-391-6917
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704217600363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704217600OtherNURSE PRACTITIONER