Provider Demographics
NPI:1710009535
Name:BROWN, FREDERICKA JOSEPHINE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:FREDERICKA
Middle Name:JOSEPHINE
Last Name:BROWN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2076 WENDYS DR
Mailing Address - Street 2:67
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2420
Mailing Address - Country:US
Mailing Address - Phone:614-493-4224
Mailing Address - Fax:
Practice Address - Street 1:2076 WENDYS DR
Practice Address - Street 2:67
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2420
Practice Address - Country:US
Practice Address - Phone:614-493-4224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH328898163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2626813Medicaid