Provider Demographics
NPI:1154035897
Name:BROWN, MENITA CHERRIE (DOULA)
Entity type:Individual
Prefix:
First Name:MENITA
Middle Name:CHERRIE
Last Name:BROWN
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-2707
Mailing Address - Country:US
Mailing Address - Phone:863-640-2187
Mailing Address - Fax:
Practice Address - Street 1:931 W 12TH ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-2707
Practice Address - Country:US
Practice Address - Phone:863-640-2187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
FL374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula