Provider Demographics
NPI:1457741811
Name:BROWN, ANDREA (LPN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9479 WINDHAM PARKMAN RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:OH
Mailing Address - Zip Code:44288-9704
Mailing Address - Country:US
Mailing Address - Phone:330-622-3530
Mailing Address - Fax:
Practice Address - Street 1:9479 WINDHAM PARKMAN RD
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:OH
Practice Address - Zip Code:44288-9704
Practice Address - Country:US
Practice Address - Phone:330-622-3530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.152763-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse