Provider Demographics
NPI:1336626365
Name:BROWN, DESTINY R (HHA)
Entity Type:Individual
Prefix:
First Name:DESTINY
Middle Name:R
Last Name:BROWN
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:DESTINY
Other - Middle Name:R
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HOME HEALTH AIDE
Mailing Address - Street 1:492 ORIOLE PL SW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44485-3633
Mailing Address - Country:US
Mailing Address - Phone:234-806-3326
Mailing Address - Fax:
Practice Address - Street 1:492 ORIOLE PL SW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44485-3633
Practice Address - Country:US
Practice Address - Phone:234-806-3326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide