Provider Demographics
NPI:1912192873
Name:BROWN, MIA JOY (LMP)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:JOY
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 15TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-5507
Mailing Address - Country:US
Mailing Address - Phone:206-784-3494
Mailing Address - Fax:206-789-2088
Practice Address - Street 1:6700 15TH AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-5507
Practice Address - Country:US
Practice Address - Phone:206-784-3494
Practice Address - Fax:206-789-2088
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022335174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist