Provider Demographics
NPI:1699386425
Name:BROWN, MADELINE SUSAN (RD)
Entity Type:Individual
Prefix:MRS
First Name:MADELINE
Middle Name:SUSAN
Last Name:BROWN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 NORTHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-3065
Mailing Address - Country:US
Mailing Address - Phone:701-226-9105
Mailing Address - Fax:
Practice Address - Street 1:77 NORTHWOOD LN
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-3065
Practice Address - Country:US
Practice Address - Phone:701-226-9105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.7973133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered