Provider Demographics
NPI:1982258612
Name:POISSON-BROWN, MALLORY SUE (HHA)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:SUE
Last Name:POISSON-BROWN
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E MCNEIL ST
Mailing Address - Street 2:
Mailing Address - City:CORUNNA
Mailing Address - State:MI
Mailing Address - Zip Code:48817-1712
Mailing Address - Country:US
Mailing Address - Phone:989-494-8810
Mailing Address - Fax:
Practice Address - Street 1:200 E MCNEIL ST
Practice Address - Street 2:
Practice Address - City:CORUNNA
Practice Address - State:MI
Practice Address - Zip Code:48817
Practice Address - Country:US
Practice Address - Phone:989-494-8810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide