Provider Demographics
NPI:1679310593
Name:BROWN, BRANDON (CHW, BA)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:CHW, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48055 THORNWOOD ST
Mailing Address - Street 2:APT 1209
Mailing Address - City:WIXOM
Mailing Address - State:MI
Mailing Address - Zip Code:48393-2623
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:48055 THORNWOOD ST
Practice Address - Street 2:APT 1209
Practice Address - City:WIXOM
Practice Address - State:MI
Practice Address - Zip Code:48393
Practice Address - Country:US
Practice Address - Phone:248-595-2804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker