Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | OS6343 | FL |
N | 207Q00000X | Family Doctor | OS6343 | FL |
NPI | 1134236201 |
---|---|
Provider Name | Juanita M Brown |
First Address | Harrogate, TN 37752-0367 |
Second Address | New Tazewell, TN 37825-6606 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F38675 | (02) |