Provider Demographics
NPI:1588901888
Name:BROWN, CAROL D (BHA1)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:D
Last Name:BROWN
Suffix:
Gender:F
Credentials:BHA1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 69
Mailing Address - Street 2:
Mailing Address - City:EEK
Mailing Address - State:AK
Mailing Address - Zip Code:99578
Mailing Address - Country:US
Mailing Address - Phone:907-536-5314
Mailing Address - Fax:907-536-5732
Practice Address - Street 1:2 COUNCIL STREET
Practice Address - Street 2:
Practice Address - City:EEK
Practice Address - State:AK
Practice Address - Zip Code:99578
Practice Address - Country:US
Practice Address - Phone:907-536-5314
Practice Address - Fax:907-536-5732
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1020986Medicaid