Provider Demographics
NPI:1689173791
Name:BROWN, KAREN (HAIR REPLACEMENT SPE)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:HAIR REPLACEMENT SPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 E PARKER ST STE 2
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-1901
Mailing Address - Country:US
Mailing Address - Phone:863-688-1234
Mailing Address - Fax:
Practice Address - Street 1:921 E PARKER ST STE 2
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-1901
Practice Address - Country:US
Practice Address - Phone:863-688-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-04
Last Update Date:2018-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCL01842921744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management