Provider Demographics
NPI:1295982544
Name:BROWN, LASTACIA MARIE
Entity type:Individual
Prefix:
First Name:LASTACIA
Middle Name:MARIE
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 1:2130 AVENIDA LAQUINTA ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-5635
Mailing Address - Country:US
Mailing Address - Phone:281-497-2441
Mailing Address - Fax:281-497-8245
Practice Address - Street 1:2130 AVENIDA LAQUINTA STREET
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-5635
Practice Address - Country:US
Practice Address - Phone:281-497-2441
Practice Address - Fax:281-497-8245
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261944395163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health