Provider Demographics
NPI:1407488810
Name:BROWN, JUANITA (CRMA,CNA,MA)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:CRMA,CNA,MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2622 CRISP APPLE WAY
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-1555
Mailing Address - Country:US
Mailing Address - Phone:713-213-4478
Mailing Address - Fax:
Practice Address - Street 1:2622 CRISP APPLE WAY
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:TX
Practice Address - Zip Code:77545-1555
Practice Address - Country:US
Practice Address - Phone:713-213-4478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide