Provider Demographics
NPI:1295943405
Name:BROWN, TAMIKA LYNETTE
Entity type:Individual
Prefix:MS
First Name:TAMIKA
Middle Name:LYNETTE
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TAMIKA
Other - Middle Name:LYNETTE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4047 MYRON AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45416-1657
Mailing Address - Country:US
Mailing Address - Phone:937-274-0022
Mailing Address - Fax:937-274-0022
Practice Address - Street 1:4047 MYRON AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45416-1657
Practice Address - Country:US
Practice Address - Phone:937-274-0022
Practice Address - Fax:937-274-0022
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH334870810800374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2621658Medicare UPIN