Provider Demographics
NPI:1992385025
Name:BROWN, ELIZA M
Entity type:Individual
Prefix:
First Name:ELIZA
Middle Name:M
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 1:3005 WESTWOOD NORTHERN BLVD APT 5
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-3628
Mailing Address - Country:US
Mailing Address - Phone:513-510-0507
Mailing Address - Fax:
Practice Address - Street 1:3005 WESTWOOD NORTHERN BLVD APT 5
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-3628
Practice Address - Country:US
Practice Address - Phone:513-510-0507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174200000XOther Service ProvidersMeals
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH863204236OtherNON MEDICAL SERVICE