Provider Demographics
NPI:1104127232
Name:BROWN, MARGO ELAINE (LPN)
Entity type:Individual
Prefix:MRS
First Name:MARGO
Middle Name:ELAINE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5224 THEODORE STREET
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-1334
Mailing Address - Country:US
Mailing Address - Phone:216-662-3737
Mailing Address - Fax:
Practice Address - Street 1:5224 THEODORE STREET
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-1334
Practice Address - Country:US
Practice Address - Phone:216-662-3737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 136318-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse