Provider Demographics
NPI:1730296070
Name:BROWN, DONNA NEALOUS (RN)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:NEALOUS
Last Name:BROWN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-3619
Mailing Address - Country:US
Mailing Address - Phone:313-579-5535
Mailing Address - Fax:
Practice Address - Street 1:603 E PHILADELPHIA ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2224
Practice Address - Country:US
Practice Address - Phone:313-664-0661
Practice Address - Fax:313-664-0661
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704229459163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice