Provider Demographics
NPI:1316644172
Name:BROWN, CLOVER (LM)
Entity type:Individual
Prefix:
First Name:CLOVER
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1199 63RD ST
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2236
Mailing Address - Country:US
Mailing Address - Phone:510-590-8289
Mailing Address - Fax:
Practice Address - Street 1:7 BRIGHTON BLVD
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-5064
Practice Address - Country:US
Practice Address - Phone:510-590-8289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CPM23020168176B00000X
CA703176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife