Provider Demographics
NPI:1740509553
Name:BROWN, TAWANA L (RD)
Entity type:Individual
Prefix:MS
First Name:TAWANA
Middle Name:L
Last Name:BROWN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
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Mailing Address - Street 1:1369 N HAMPTON RD APT 101
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-3177
Mailing Address - Country:US
Mailing Address - Phone:972-223-6504
Mailing Address - Fax:972-223-6504
Practice Address - Street 1:4500 S LANCASTER RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:214-857-4294
Practice Address - Fax:214-857-0092
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXDT81399133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered