Provider Demographics
NPI:1689407926
Name:ELAM-BROWN, TAWANDA LUCILLE
Entity type:Individual
Prefix:MRS
First Name:TAWANDA
Middle Name:LUCILLE
Last Name:ELAM-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 1:12442 LIMONITE AVE UNIT 205
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:91752-2467
Mailing Address - Country:US
Mailing Address - Phone:909-429-2864
Mailing Address - Fax:
Practice Address - Street 1:12442 LIMONITE AVE UNIT 205
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:91752-2467
Practice Address - Country:US
Practice Address - Phone:909-429-2864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-22
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95031812363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily