Provider Demographics
NPI:1750558912
Name:BROWN, MARIA LOUISE (RD/LD)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:LOUISE
Last Name:BROWN
Suffix:
Gender:F
Credentials:RD/LD
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:LOUISE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD/LD
Mailing Address - Street 1:100 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5674
Mailing Address - Country:US
Mailing Address - Phone:979-297-4411
Mailing Address - Fax:
Practice Address - Street 1:100 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5674
Practice Address - Country:US
Practice Address - Phone:979-297-4411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06864133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered