Provider Demographics
NPI:1265988968
Name:BROWN, TERRI (CNHP LDHP BCC)
Entity type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:CNHP LDHP BCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434
Mailing Address - Country:US
Mailing Address - Phone:757-642-5899
Mailing Address - Fax:
Practice Address - Street 1:700 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-6103
Practice Address - Country:US
Practice Address - Phone:757-642-5899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAU-9586896133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA133NN1002XOtherNUTRIRIONAL EDUCATION