Provider Demographics
NPI:1770942120
Name:BROWN, LYNISE
Entity type:Individual
Prefix:
First Name:LYNISE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 MORGAN AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44306-1447
Mailing Address - Country:US
Mailing Address - Phone:330-785-1272
Mailing Address - Fax:
Practice Address - Street 1:707 MORGAN AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-1447
Practice Address - Country:US
Practice Address - Phone:330-785-1272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-14
Last Update Date:2016-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13-01955-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH13-01955-1Other13-01955-1