Provider Demographics
NPI:1710749023
Name:BROWN, REGINA LYNNETTE
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:LYNNETTE
Last Name: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 1:17356 W 12 MILE RD STE 206
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-6316
Mailing Address - Country:US
Mailing Address - Phone:313-293-2944
Mailing Address - Fax:855-727-7552
Practice Address - Street 1:17356 W 12 MILE RD STE 206
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-6316
Practice Address - Country:US
Practice Address - Phone:313-293-2944
Practice Address - Fax:855-727-7552
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health