Provider Demographics
NPI:1780225581
Name:BROWN, CHIQUANA
Entity Type:Individual
Prefix:
First Name:CHIQUANA
Middle Name:
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 1:7710 W INTERSTATE 10
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-4711
Mailing Address - Country:US
Mailing Address - Phone:210-377-3355
Mailing Address - Fax:210-377-3356
Practice Address - Street 1:1133 POLO DR
Practice Address - Street 2:SHE 104
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017
Practice Address - Country:US
Practice Address - Phone:901-472-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA0008538145376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide