Provider Demographics
NPI:1972868222
Name:O'NEAL-BROWN, EFFIE
Entity Type:Individual
Prefix:MRS
First Name:EFFIE
Middle Name:
Last Name:O'NEAL-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 1:23579 KARL DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:MI
Mailing Address - Zip Code:48134-9188
Mailing Address - Country:US
Mailing Address - Phone:734-692-0107
Mailing Address - Fax:
Practice Address - Street 1:23579 KARLDR.
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN
Practice Address - State:MI
Practice Address - Zip Code:48134
Practice Address - Country:US
Practice Address - Phone:734-692-0107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703109132164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse