Provider Demographics
NPI:1730471467
Name:BROWN, MARKEIDA NIKKOLE
Entity Type:Individual
Prefix:MISS
First Name:MARKEIDA
Middle Name:NIKKOLE
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 1:193 SHANK AVE
Mailing Address - Street 2:
Mailing Address - City:TROTWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45426-3438
Mailing Address - Country:US
Mailing Address - Phone:937-580-1114
Mailing Address - Fax:
Practice Address - Street 1:193 SHANK AVE
Practice Address - Street 2:
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45426-3438
Practice Address - Country:US
Practice Address - Phone:937-580-1114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH321444470406376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide