Provider Demographics
NPI:1609631555
Name:PERNELL-BROWN, ANTOINEQUE
Entity Type:Individual
Prefix:
First Name:ANTOINEQUE
Middle Name:
Last Name:PERNELL-BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5624 ASPEN DR APT A
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-8414
Mailing Address - Country:US
Mailing Address - Phone:567-377-9694
Mailing Address - Fax:
Practice Address - Street 1:5624 ASPEN DR APT A
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-8414
Practice Address - Country:US
Practice Address - Phone:567-377-9694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant