Provider Demographics
NPI:1659822260
Name:BROWN, VICKI
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
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 1:2252 29TH ST SW APT 1
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-2563
Mailing Address - Country:US
Mailing Address - Phone:616-432-7480
Mailing Address - Fax:
Practice Address - Street 1:2252 29TH ST SW APT 1
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-2563
Practice Address - Country:US
Practice Address - Phone:616-432-7480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide