Provider Demographics
NPI:1669082442
Name:BROWN, TONIETTE (RN)
Entity type:Individual
Prefix:
First Name:TONIETTE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14108 EDGEWOOD AVE # UP
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-1069
Mailing Address - Country:US
Mailing Address - Phone:804-319-0421
Mailing Address - Fax:
Practice Address - Street 1:14108 EDGEWOOD AVE # UP
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-1069
Practice Address - Country:US
Practice Address - Phone:804-319-0421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-05
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002090674164W00000X
OHLPN.170448.MEDS-IV164W00000X
OHRN.483302163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse