Provider Demographics
NPI:1972193571
Name:BROWN, ANGELA LYNN
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYNN
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 1:1521 LITTLE LEFTHAND RD
Mailing Address - Street 2:
Mailing Address - City:AMMA
Mailing Address - State:WV
Mailing Address - Zip Code:25005-9019
Mailing Address - Country:US
Mailing Address - Phone:304-415-5972
Mailing Address - Fax:
Practice Address - Street 1:1521 LITTLE LEFTHAND RD
Practice Address - Street 2:
Practice Address - City:AMMA
Practice Address - State:WV
Practice Address - Zip Code:25005-9019
Practice Address - Country:US
Practice Address - Phone:304-415-5972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant