Provider Demographics
NPI:1063109742
Name:BROWN, ROCHELLE NANETTE
Entity type:Individual
Prefix:MRS
First Name:ROCHELLE
Middle Name:NANETTE
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 1:849 BLANCHE ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-3643
Mailing Address - Country:US
Mailing Address - Phone:937-231-3822
Mailing Address - Fax:
Practice Address - Street 1:849 BLANCHE ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-3643
Practice Address - Country:US
Practice Address - Phone:937-231-3822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRT034342172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver