Provider Demographics
NPI:1316664931
Name:BROWN, CONNIE YVONNE
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:YVONNE
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 1:4822 ALBEMARLE RD STE 101M
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-6630
Mailing Address - Country:US
Mailing Address - Phone:704-793-7668
Mailing Address - Fax:704-817-8891
Practice Address - Street 1:4822 ALBEMARLE RD STE 101M
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-6630
Practice Address - Country:US
Practice Address - Phone:704-793-7668
Practice Address - Fax:704-817-8891
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC86-1109510OtherTRANSPORTATION COMPANY
NC861109510OtherKINGDOM TRANSPORTATION