Provider Demographics
NPI:1881877157
Name:BROWN, LORETTA ANN
Entity type:Individual
Prefix:MISS
First Name:LORETTA
Middle Name:ANN
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 1:1315 CHASE TRL
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5758
Mailing Address - Country:US
Mailing Address - Phone:817-539-0043
Mailing Address - Fax:817-539-0043
Practice Address - Street 1:1315 CHASE TRL
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5758
Practice Address - Country:US
Practice Address - Phone:817-539-0043
Practice Address - Fax:817-539-0043
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health