Provider Demographics
NPI:1336213982
Name:BROWN, KACYNDA MARSHALL (CNA)
Entity Type:Individual
Prefix:
First Name:KACYNDA
Middle Name:MARSHALL
Last Name:BROWN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6320 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-2010
Mailing Address - Country:US
Mailing Address - Phone:215-927-0926
Mailing Address - Fax:
Practice Address - Street 1:6320 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-2010
Practice Address - Country:US
Practice Address - Phone:215-927-0926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA9968183376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide