Provider Demographics
NPI:1659820306
Name:BROWNELL, ANN
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:BROWNELL
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 1:527 BOYETTE RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:GA
Mailing Address - Zip Code:31635-5238
Mailing Address - Country:US
Mailing Address - Phone:402-677-5866
Mailing Address - Fax:
Practice Address - Street 1:527 BOYETTE RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:GA
Practice Address - Zip Code:31635-5238
Practice Address - Country:US
Practice Address - Phone:402-677-5866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA171W0000X171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor