Provider Demographics
NPI:1316283088
Name:BROWN, PATRICIA (STNA)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10285 FAXON CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-1006
Mailing Address - Country:US
Mailing Address - Phone:513-772-2159
Mailing Address - Fax:
Practice Address - Street 1:10285 FAXON CT
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-1006
Practice Address - Country:US
Practice Address - Phone:513-772-2159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400314931203311ZA0620X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH313246283301OtherMEDICARE NUMBER
OH256284362C5Medicaid