Provider Demographics
NPI:1982963401
Name:BROWN, VANESSA SUZETTE
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:SUZETTE
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 1:3002 BRINKLEY RD APT T2
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-6133
Mailing Address - Country:US
Mailing Address - Phone:202-417-0819
Mailing Address - Fax:
Practice Address - Street 1:3002 BRINKLEY RD APT T2
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-6133
Practice Address - Country:US
Practice Address - Phone:202-417-0819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-04
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA5638374U00000X
171M00000X
MDB650839778364251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide
No251E00000XAgenciesHome Health