Provider Demographics
NPI:1720609787
Name:BROWN, DOMINIQUE TENNA
Entity type:Individual
Prefix:MS
First Name:DOMINIQUE
Middle Name:TENNA
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 1:2912 GUERRA DR
Mailing Address - Street 2:
Mailing Address - City:VIOLET
Mailing Address - State:LA
Mailing Address - Zip Code:70092-2935
Mailing Address - Country:US
Mailing Address - Phone:504-914-3189
Mailing Address - Fax:
Practice Address - Street 1:2912 GUERRA DR
Practice Address - Street 2:
Practice Address - City:VIOLET
Practice Address - State:LA
Practice Address - Zip Code:70092-2935
Practice Address - Country:US
Practice Address - Phone:504-914-3189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)