Provider Demographics
NPI:1023479953
Name:BROWN, ANISSA CAREY
Entity type:Individual
Prefix:
First Name:ANISSA
Middle Name:CAREY
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 1:104 MARTENSE ST
Mailing Address - Street 2:AP 3B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-3388
Mailing Address - Country:US
Mailing Address - Phone:347-539-6064
Mailing Address - Fax:
Practice Address - Street 1:104 MARTENSE ST
Practice Address - Street 2:AP 3B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-3388
Practice Address - Country:US
Practice Address - Phone:347-539-6064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-21
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300335-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health