Provider Demographics
NPI:1639867427
Name:BROWN, TYESHIA NICOLE
Entity Type:Individual
Prefix:
First Name:TYESHIA
Middle Name:NICOLE
Last Name: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:PO BOX 2002
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48333-2002
Mailing Address - Country:US
Mailing Address - Phone:248-599-1848
Mailing Address - Fax:
Practice Address - Street 1:4650 S TELEGRAPH RD TRLR 41
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48125-1955
Practice Address - Country:US
Practice Address - Phone:248-599-1848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health