Provider Demographics
NPI:1417663642
Name:MOSES BROWN, GLORIA YVONNE (NP)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:YVONNE
Last Name:MOSES BROWN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1363 DOWN RIVER DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-9038
Mailing Address - Country:US
Mailing Address - Phone:901-692-2225
Mailing Address - Fax:
Practice Address - Street 1:1363 DOWN RIVER DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-9038
Practice Address - Country:US
Practice Address - Phone:901-692-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000030852163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology