Provider Demographics
NPI:1689181372
Name:BROWN, TALETHA K (APN)
Entity Type:Individual
Prefix:
First Name:TALETHA
Middle Name:K
Last Name:BROWN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 QUEENS LN
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:IL
Mailing Address - Zip Code:60476-1080
Mailing Address - Country:US
Mailing Address - Phone:708-564-5071
Mailing Address - Fax:
Practice Address - Street 1:3530 W PETERSON AVE STE 201
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3215
Practice Address - Country:US
Practice Address - Phone:773-839-5415
Practice Address - Fax:773-831-1706
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-04
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209016986363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily