Provider Demographics
NPI:1841864253
Name:BROWN, OLIVIA A
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:A
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 1:1050 E UNIVERSITY DR STE 6
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-8046
Mailing Address - Country:US
Mailing Address - Phone:702-561-9253
Mailing Address - Fax:855-888-3130
Practice Address - Street 1:1050 E UNIVERSITY DR STE 6
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-8046
Practice Address - Country:US
Practice Address - Phone:702-561-9253
Practice Address - Fax:855-888-3130
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor