Provider Demographics
NPI:1689804791
Name:MANCHESTER-BROWN, CAROL DENISE
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:DENISE
Last Name:MANCHESTER-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 8032
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88355-8032
Mailing Address - Country:US
Mailing Address - Phone:575-937-0977
Mailing Address - Fax:575-257-1569
Practice Address - Street 1:723 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6758
Practice Address - Country:US
Practice Address - Phone:575-937-0977
Practice Address - Fax:575-257-1569
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2206 QBS246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other