Provider Demographics
NPI:1801671953
Name:BROWN, LA TESHA SHAREE (MSN, BSN, RN)
Entity type:Individual
Prefix:
First Name:LA TESHA
Middle Name:SHAREE
Last Name:BROWN
Suffix:
Gender:F
Credentials:MSN, BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 VERNON ST APT 207
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-3053
Mailing Address - Country:US
Mailing Address - Phone:408-931-2964
Mailing Address - Fax:
Practice Address - Street 1:3514 LYNDALE AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55412-2558
Practice Address - Country:US
Practice Address - Phone:612-803-5038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9068235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty