Provider Demographics
NPI:1407198799
Name:BROWN, MARQUETTA SHENEEN (STNA)
Entity Type:Individual
Prefix:
First Name:MARQUETTA
Middle Name:SHENEEN
Last Name:BROWN
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26460 SHOREVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-1456
Mailing Address - Country:US
Mailing Address - Phone:216-551-5020
Mailing Address - Fax:
Practice Address - Street 1:26460 SHOREVIEW AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-1456
Practice Address - Country:US
Practice Address - Phone:216-551-5020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400663910907376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide