Provider Demographics
NPI:1770328551
Name:ELDER, BROWNIE CELESTE
Entity type:Individual
Prefix:MRS
First Name:BROWNIE
Middle Name:CELESTE
Last Name:ELDER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:BROWNIE
Other - Middle Name:
Other - Last Name:ELDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3095 SCARLET OAK DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-3918
Mailing Address - Country:US
Mailing Address - Phone:209-922-6292
Mailing Address - Fax:
Practice Address - Street 1:3095 SCARLET OAK DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-3918
Practice Address - Country:US
Practice Address - Phone:209-922-6290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-25
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343900000X
CA22-00133685172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriver
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Single Specialty