Provider Demographics
NPI:1790535581
Name:BROWN, SONJA
Entity Type:Individual
Prefix:
First Name:SONJA
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 1:5820 SULLIVANT AVE UNIT 492
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:OH
Mailing Address - Zip Code:43119-7523
Mailing Address - Country:US
Mailing Address - Phone:419-356-5576
Mailing Address - Fax:
Practice Address - Street 1:5820 SULLIVANT AVE UNIT 492
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:OH
Practice Address - Zip Code:43119-7523
Practice Address - Country:US
Practice Address - Phone:419-356-5576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4810236374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide