Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 901414 | MS |
NPI | 1083071237 |
---|---|
Provider Name | Wanda Brown |
First Address | Memphis, TN 38104-0978 |
Second Address | Southaven, MS 38671-6726 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2016 |
Last Update Date | 19/01/2016 |