Provider Demographics
NPI:1245832856
Name:BROWN, ANNA MAE
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:MAE
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 1:8949 COUNTY ROAD 235
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75707-4327
Mailing Address - Country:US
Mailing Address - Phone:903-617-9903
Mailing Address - Fax:
Practice Address - Street 1:8949 COUNTY ROAD 235
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75707-4327
Practice Address - Country:US
Practice Address - Phone:903-617-9903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1018520163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse