Basic Information
| Provider Information | |||||||||
| NPI: | 1003363789 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | LATOYA | ||||||||
| MiddleName: | SHERESE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3016 WOODBRIDGE DR SE APT 203 | ||||||||
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| City: | KENTWOOD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495121966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6168348383 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3351 36TH ST SE | ||||||||
| Address2: | |||||||||
| City: | KENTWOOD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495122809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6169422522 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2016 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | N | Technologists, Technicians & Other Technical Service Providers | Technician, Other | 106S00000X | Y |
No ID Information.