Provider Demographics
NPI:1538640628
Name:BROWN, DONNELL COREY JR (NURSE AIDE)
Entity Type:Individual
Prefix:MR
First Name:DONNELL
Middle Name:COREY
Last Name:BROWN
Suffix:JR
Gender:M
Credentials:NURSE AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 203
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27289
Mailing Address - Country:US
Mailing Address - Phone:336-613-0473
Mailing Address - Fax:
Practice Address - Street 1:519 ORCHARD DRIVE
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288
Practice Address - Country:US
Practice Address - Phone:336-613-0473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
NC425786376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant