Provider Demographics
NPI:1306618640
Name:BROWN, KEYONNA (RN)
Entity type:Individual
Prefix:
First Name:KEYONNA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 LODGE AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43609-3028
Mailing Address - Country:US
Mailing Address - Phone:419-378-1169
Mailing Address - Fax:
Practice Address - Street 1:4239 PACKARD RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612-1939
Practice Address - Country:US
Practice Address - Phone:419-378-1169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH516925163WC3500X, 163WR0400X, 163W00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC3500XNursing Service ProvidersRegistered NurseCardiac Rehabilitation
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation
No251E00000XAgenciesHome Health